Haem: Obstetric Haematology Pt.1 Flashcards

1
Q

What haematological changes are seen on FBC in pregnancy?

A
  • Mild anaemia (DILUTION)
    • Red cell mass rises (120-130%)
    • Plasma volume rises (150%)
  • Macrocytosis
    • Normal
    • Folate or B12 deficiency
  • Neutrophilia
  • Thrombocytopenia
    • Increased platelet size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 Hb thresholds for anaemia in pregnancy?

A

<110 in 1st trimester

<105 in 2nd/ 3rd trimester

<100 post partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the increased demands required in pregnancy?

A
  • Iron requirement
    • 300mg for fetus
    • 500mg for maternal increased red cell mass
  • Folate requirements increase
    • Growth and cell division
    • Approx additional 200mcg/day required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How iron deficiency diagnosed?
What is the treatment for iron deficiency in pregnancy?

A

FBC: Low Hb, MCV < 80

200 mg ferrous sulfate daily for 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does iron deficiency during pregnancy increase risk of?

A

IUGR

Prematurity

Postpartum haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is normal iron absorption per day?

What is iron absorption during pregnancy?

A

Normal absorption 1-2mg a day.

This increases to 6mg during pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is iron absorption increased during pregnancy?

A

Hepcidin decreases and ferroportin levels increase. This results in increased iron absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the RCOG recommendation for daily folate intake?

A

400 mcg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does folate deficiency increase risk of during pregnancy?

A

Neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the cut off level of platelets required for:

  1. Epidural anaethesia
  2. Delivery
A
  1. > 70 x10^9/L
  2. > 50 x10^9/L

Higher for epidural due to serious risk of spinal haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are causes of thrombocytopenia in pregnancy?

A
  • Physiological:
    • ‘gestational’ / incidental thrombocytopenia
  • Pre-eclampsia
  • Immune thrombocytopenia (ITP)
  • Microangiopathic syndromes
  • All other causes: bone marrow failure, leukaemia, hypersplenism, DIC etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most commone cause of thrombocytopaenia <150x109/L in pregnancy?

A

Gestational thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common cause of thrombocytopaenia <100x109/L in pregnancy?

A

ITP and pre-eclampsia

This suggests something pathological is occurring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is gestational thrombocytopenia?

A

A physiological decrease in platelet count of about 10% during pregnancy
Does not affect foetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the underlying mechanism of gestational thrombocytopenia?

A

Mechanism poorly defined.

Possibly due to dilution and increased consumption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When does platelet count increase following gestational thrombocytopenia?

A

Platelet count rises around 2-5 days after delivery

17
Q

When does platelet count fall most during pregnancy in gestational thrombocytopenia?

A

Most of the fallen platelet count occurs in 3rd trimester

18
Q

What percent of women with preeclampsia get thrombocytopenia?

A

50%

Thrombocytopenia is proportionate to severity of preeclampsia.

19
Q

What causes thrombocytopenia in preeclampsia?

A

Increased activation and consumption of platelets due endothelial injury

20
Q

What percentage of thrombocytopenia during pregnancy is accounted for by immune thrombocytopenia (ITP)?

A

5% of thrombocytopenia in pregnancy

  • TP may precede pregnancy
  • Early onset
21
Q

What are the treatment options for ITP in pregnancy?

A
  • IVIG (FIRST LINE)
  • Steroids (not ideal as lots of side effects)