Antenatal care in thalassemia

Question 1

Timing of antenatal visits in women with thalassemia

Answer 1

• Monthly until 28 weeks and fortnightly thereafter
• Women with both thalassaemia and diabetes should have monthly assessment of serum fructosamine
  concentrations
• Women with thalassaemia major should undergo specialist cardiac assessment at 28 weeks and thereafter as appropriate

Question 2

Timing of USS in thalassemia

Answer 2

• Early scan at 7–9 weeks of gestation

- Serial scans every 4 weeks from 24 weeks

Question 3

Blood transfusion schedule in thalassemia

Answer 3

• Thalassaemia major: blood tx on a regular basis aiming for a pretransfusion hb of 100 g/l
• Thalassemia intermedia: If there is worsening maternal anaemia or evidence of FGR, regular transfusions should be considered and hb targets are as for thalassaemia major
• 2–3 unit transfusion with additional top-up transfusion if necessary the following week until the hb reaches 120 g/l
• The hb should be monitored after 2 to 3 weeks and a 2-unit transfusion administered if below 100 g/l
• if the hb is above 80 g/l at 36 weeks of gestation, transfusion can be avoided prior to delivery.

Question 4

Thromboprophylaxis and thalassemia

Answer 4

• Splenectomy OR a platelet count greater than
  600 x 109/l: commence or continue taking low-dose aspirin (75 mg/day)
• splenectomy AND a platelet count above
  600 x 109 /l: low-molecular-weight heparin thromboprophylaxis as well as low-dose
  aspirin (75 mg/day)
• Risk of VTE is highest in splenectomised women with thalassaemia intermedia who are not receiving
  transfusions since a good transfusion regimen suppresses endogenous erythropoiesis

Question 5

Chelation during pregangy in thalassemia

Answer 5

Low-dose subcutaneous desferrioxamine (20 mg/kg/day) on a minimum of 4–5 days a week from 20–24 weeks of gestation for women at high risk of cardiac decompensation