Blood disorders in pregnaancy

Question 1

What values in reticulocytes show a good response to supplementation/ or diet changes?

Answer 1

INCREASED % of reticulocytes range of 5-7% (normal range is 1-2%

Question 2

What is the nadir of Hgb/Hct in pregnancy? What is the low end of normal at this time?

Answer 2

24-28 weeks 10.5/ 33

Question 3

What is the relationship between plasma volume a baby size?

Answer 3

High plasma volume associated with larger babies

Question 4

What lab value, in conjucntion with low H and H indicates Microcytic anemia. What nutritional deficits are associated with this?

Answer 4

MCV < 80. Iron deficency

Question 5

What lav value, in conjunction with low H/H indicates Macrocytic anemia. What nutritional deficits are associated with this?

Answer 5

MCV >98 Associated with folate of B-12 deficiency

Question 6

what does MCH measure? What is a low value and with what condition is a low value associated?

Answer 6

MCV, measures pigment concentration, which indicates concentration of hemoglobin. A value less than 27 indicate iron deficiency.

Question 7

How red blood cell size variation (Measured by RDW) %) help differentiate iron deficiency anemia from thalassemia minor?

Answer 7

Iron deficiency causes greater variation in the size of red blood cells and RDW greater than 14% indicate iron deficiency anemia

Question 8

What are all the lat values associated with iron deficiency anemia?

Answer 8

Low H/h: Less than< 11/33 (depending on trimester)
Low MCV (measures cell volume):  < 80
Low MCH (measures hemoglobin concentration per RBC):  < 27
Low MCHC (measures average concentration of hemoglobin: < 32

Question 9

How long can it take to restore all iron lost in pregnancy?

Answer 9

up to two years

Question 10

What form of iron is more easily absorbed Ferrous or Ferric?

Answer 10

Ferrous

Question 11

How much elemental iron is in a 325 mg tablet of Iron Sulfate (FeSO4) How common are adverse GI effects?

Answer 11

60-65mg. About 1/3 of people have adverse effects with Iron sulfate

Question 12

How much elemental iron is in a 325 mg tablet of Ferrous gluconate? How common are adverse GI effects?

Answer 12

37-39mg About 1/3 of people have adverse effects with Iron gluconate

Question 13

How much elemental iron is in a 325mg tablet of ferrous fumerate? How common are adverse GI effects?

Answer 13

105mg, about 1/2 of people have them

Question 14

How does smoking and elevation effect the normal range of H/H?

Answer 14

People who smoke or live at higher elevation need a higher H/H to have normal levels. at elevation this means and Hgb about 13. In people who smoke Hgb should be increased by 0.3-0.7 g/dl depending on the ammout they smoke

Question 15

At what Hgb level are there increased risks for preterm birth and low birth weight?

Answer 15

Hgb < 9.5

Question 16

At what Hgb level are there increased risks for IUFD or SAB?

Answer 16

Hgb < 6

Question 17

What serum Ferritin level is concerning?

Answer 17

below 30

Question 18

How much elemental iron is in 300mg of Iron protein succinylate? How common are adverse effects?

Answer 18

only 18 mg/ 300mg. But lowest rate of adverse effects at 7%

Question 19

What values indicate folate deficiency?

Answer 19

decreased RBCs, MCV greater than 1000. normal range Ferritin

Question 20

In addition to anemia what are s/s of folate deficiency?

Answer 20

• low serum B12
• hyperpigmentation
• low grade fever
• numbness and tingling in the extremities
• decreased mental alertness and memory problems.

Question 21

What is the prophylactic dose of folate for women with a normal pregnancy?
What is the treatment dose for folate deficiency?
What is the prophylactic dose of folate for someone with a history of neural tube defects?

Answer 21

• 400 ug daily
• 5mg daily for 4 months or throughout pregnancy
• 4mg preconception and first 4month of pregnany

Question 22

What are common causes of B 12 deficiency (5) ?

Answer 22

• history of bariatric surgery
• use of metformin
• use of proton pump inhibitor
• bowel diseases such as Crohn’s disease
• people with strict vegan diet

Question 23

What are risks for people with Sickle cell trait in pregnancy (Hets with 1 copy)? 4 answers

Answer 23

• PET
• low birth weight
• pp endometritis
• UTIs

Question 24

Managment of Sickle cell trait

Answer 24

• get urine culture each trimester due to increased risk of UTI and pylonephritis
• screen patient and partner
• notify anesthesiologist in case of C section

Question 25

Thrombocytopenia occours in 6-15% of patients in pregnancy it is generally benign. What is lab value indicate this condition and what pathologic conditions may be associate with it?

Answer 25

platelet value below 150,000/mm
pathologic conditions: 
-preeclampsia
- HELLP syndrome
- Immune Trhombocytopenia

Question 26

The are many Rh antigens what is the most immunogenic?

Answer 26

D

Question 27

What percent of people are Rh negative

Answer 27

about 15%, slighlt higher in black populations

Question 28

What is Rh allomimmunization/ Isoimmunization?

Answer 28

The process of antibodies target Rh postive RBCs to be destroyed

Question 29

What is the effect of ABO incomplatibility on Rh sensitization?

Answer 29

ABO incompatability recues Rh sensitization to 1-2%, becuase they are already targeted to be destroyed.

Question 30

What are the common doses for RhoGam? How much is usually given?

Answer 30

common prophylatic does at 28 week is 300uG and same dose at within 72 hours of birth of Rh positive baby. Protects against 30mL of blood. Calculations can also be made of how much blood was exchanged and dosed accordingly. 50mcg/ 2.5mL of Rh + RBCs.

Question 31

What antibodies are associated with severe disease ( 3) ?

Answer 31

• Kell
• Duffy
• Rhesus