Haematological Conditions & Infectious Diseases Flashcards
1
Q
What is the composition of blood
A
55% Plasma
45% Red blood cells (erythrocytes)
0.1% White blood cells (leukocytes)
0.17% Platelets (thrombocytes)
2
Q
What is plasma made up of
A
91% water
7% proteins
2% other solutes
3
Q
What is the formed elements of blood made up of
A
Platelets
White blood cells
Red blood cells
4
Q
Explain: Plasma
A
liquid part of blood
- pale yellow
- is a colloid solution
Contains:
- albumin
- globulins
- fibrinogen
5
Q
Describe: Ethryrocytes
A
- no nucleaus
- made up of hemoglobin, lipids, ATP and carbonic anhydrase
- They transport oxygen from lungs to tissues and carbon dioxide from tissues to lungs
6
Q
Describe: Hemaglobin
A
Consists of:
- 4 globin molecules: Transport carbon dioxide (carbonic anhydrase involved), nitric oxide
- 4 heme molecules: Transport oxygen
- Iron is required for oxygen transport
7
Q
Define: Erythropoiesis
A
is the process by which new erythrocytes are made.
- It is stimulated by a decrease in oxygen in the blood
- detected by the kidneys
- kidney’s then secrete hormone erythropoiesis.
8
Q
List types of Leukocytes
A
Neutrophils: Eosinophils: Basophils: Lymphocytes: Monocytes:
9
Q
Define: Hemostasis
A
is the process by which bleeding is stopped, which prevents excessive blood loss
10
Q
What are the 3 steps on Hemostasis
A
Vascular spasm: smooth muscle of blood vessel contracts and pinches off blood supply to area injured
Platelet plug formation: Platelets detect and adhere to injured site, band together and release contents, ADP makes platelets sticky so other platelets stick to existing ones creating a platelet plug
Coagulation or blood clotting: aim is to contain blood into a gel.
11
Q
What determines the a blood groups Rh
A
If a D antigen is present: Rh Positive (85% population)
Id D antigen is not present: Rh Negative (15% population)
12
Q
Explain: Beta-Thalamassaemia
A
a group of hereditary disorders characterised by a genetic deficiency in the synthesis of beta-globin chain
Symptoms: Pallor Lethargy Poor appetite Developmental delay Failure to thrive Irritability, difficulty settling Splenomegaly, growth failure with bone changes, fractures and leg ulcers also develop during childhood Haemolytic anaemia Carriers for β-thalassaemia are usually asymptomatic but may have mild hypochromic anaemia
13
Q
Explain: Alpha-Thalassaemia
A
is caused my a mutation in the alpha gene of the hemaglobin molecule
14
Q
If a woman tests positive for thalassaemia or has a known family history, what needs to happen
A
She needs genetic counselling
Partner needs to be tested
15
Q
Explain: Sickle Cell Disease
A
is an autosomal receptive condition caused by a mutation in both copies of the β-(beta) globin genes
- carriers have 50% chance of passing the mutated gene onto their infant
- Most common inherited conditions of hemoglobin worldwide
Symptoms: • Anaemia • Failure to thrive • Repeated infections • Painful swelling of the hands or feet • Infarction • Asplenia • Abdominal pain • Chest pain
16
Q
Explain: Sickle cell trait
A
(term to describe the carrier state) is caused by a mutation in one copy of the β-globin
- carriers are usually healthy
17
Q
Explain: Sickle cell pregnancy, labour/birth and postantal management
A
The risk in pregnancy depends on whether the woman has sickle cell disease or the sickle cell trait
Pregnancy
- Sickle cell trait women- not at risk of significant pregnancy problems.
- Specialist management
- Iron deficient anaemia, need suppliment
- May experience frequent UTI.
- Hyperemesis may cause dehydration
- U/S (IUGR)
Labour/Birth
- IV fluids
- pain relief
- At risk: premature birth, placental abruption
- Mobilisation (immobility can cause sickle cell crises)
- PPH risk
Postnatal
- Monitor for PPH, dehydration, sickle cell crises
- Baby: screening for SC
18
Q
What are 3 causes of Anaemia
A
- Inadequate production of erythrocytes: dietary, low bone marrow production, autoimmune reaction or disease
Rapid destruction of erythroctes: liver disease, lupus, sickle cell disease, malaria
Blood loss: gastrointestinal bleeding, haemophilia, haemorrhoids
19
Q
Define: Coagulopathy
A
is any condition where there is impaired clotting ability
- inc. reduced ability or inability to clot and an extra ability to clot
20
Q
What are the 2 main types of coagulopathy
A
Inherited: Autosomal dominant deficiencies
Aquired: occur in chronic disease state, after severe infection/viral infection, or with VitK deficiency
21
Q
What is the diagnostic criteria for Thrombocytopaenia
A
Normal range: 150 000 to 450 000/ per microLitre
Diagnostic: <50 000 Signs and symptoms: Petichiea Bleeding gums Nosebleeds Malaise
22
Q
Define: Thrombocytopaenia
A
is an abnormally low amount of thrombocytes (platelets)
23
Q
What are some cause of Thrombocytopaenia
A
Decreased platelet production: Leukaemia, anaemia, viral infections, HIV
Increased destruction: Autoimmune diseases, Blood borne bacterial infection
Medication induced: Quinine, alcohol abuse, interferon, chemotherapy, sulphur antibiotics
24
Q
List common pre-existing infectious diseases
A
Herpes simplex Hepatitis C Hepatitis B Sexually acquired Rubella Varicella Zoster Recurrent urinary tract infection Chlamydia Helicobacter pylori Group B streptococcus
25
What are 4 organisms responsible for infections in pregnancy
- Viral
- Bacterial
- Fungal
- Protozoan
26
What are 6 most common no-sexually transmitted infections
- Urinary tract infections - bacteriuria
- Bacterial vaginosis (BV)
- Candidiasis
- Group B streptococcus infection (GBS)
- Hepatitis B & C
27
What are 7 most common STIs
- Chlamydia
- Gonorrhea
- Herpes simplex virus type 2 (genital herpes)
- Human immunodeficiency virus (HIV)
- Human papillomavirus (HPV)
- Syphilis (Treponema pallidum)
- Trichomoniasis
28
Explain: UTI
Cause: often bacteria from the GI tract contaminating the perineal area
- common causative organisms: coliforms especially Escherichia coli, Klebsiella pneumoniae and Proteus species
Asympomatic bacturia: occurs in 2-10% of the pregnant population. During pregnancy, if the bacteriuria is left untreated 20-30%% of women will develop symptoms of UTI or pyelonephritis
Symptomatic bacteriuria: occurs in another 1-1.5%. Women with a UTI history and current bacteriuria are 10 times more likely to develop symptoms during pregnancy than women without either feature
29
What are the signs and symptoms of Acute cystitis infection and Kidney infection
Acute cystitis infection:
Frequency, dysuria, and urgency of urination or suprapubic or low back pain, haematuria
.Kidney infection: Pyelonephritis is usually present when fever, chills, nausea and vomiting, malaise and flank pain occur (CVAT)
- Incidence 1-2.5% with an increased risk of recurrence
30
Explain: Management of UTI
- Antibiotics as per organism sensitivity: 7-10 day course
- Increase fluids 1.5-2 litres/day
- void before and after intercourse to decrease the risk of recurrent UTI
- Hygiene: perineal hygiene, cotton underwear, avoidance of scented soaps, avoid tight fitting clothes
- Probiotoc intake while on antibiotic
31
What are 3 main types of Vaginal/Vulva infections
Bacterial vaginosis: anaerobic bacteria which change the normal vaginal flora to a small amount of lactobacilli which would normally produce lactic acid and maintain an acid pH
Trichomoniasis: vaginal infection caused by Trichomonas vaginalis, a flagellate protozoan that is most commonly sexually transmitted
Candidiasis: fungal infection causing vulvitis, vaginitis and vaginal discharge.
32
Explain: Bacterial Vaginosis in pregnancy
BV is present in up to 20% of women and the majority are asymptomatic
Main symptoms
- thin, grey/white vaginal discharge,
- may have increased vaginal discharge
- characterised by a fishy odour after intercourse
- Does not cause vaginal itching or dysuria
Effect on pregnancy
- increases the risk of spontaneous abortion
- PROM
- TPL an LBW infants
- May cause neonatal septicaemia and postpartum endometritis
33
Explain: Management of Bacterial Vaginosis
Treatment: Antibiotics are highly effective. 7 day course of metronidazole (Flagyl) or oral clindamycin
34
Explain: Trichomoniasis in pregnancy
Signs/Symptoms:
- Constant perineal itching
- vaginal discharge may be profuse
- frothy, yellow/green or grey and have a foul odour
- dyspareunia
- mild dysuria and lower abdominal pain
Effect on pregnancy
- Implicated in PROM, LBW and preterm birth
35
Explain: Management of Trichomoniasis
Treatment is for 5-7 days daily or in a large single dose of oral metrondiazole (Flagyl) and
- Treat the partner(s) too.
36
Explain: Candidiasis in pregnancy
Is a commensal and is found in the flora of the mouth, GIT and vagina
- Highest candidal colonisation rate in pregnancy is the third trimester with up to 50% of women affected
Signs/Symptoms
- Vaginal and vulva irritation
- pruritic
- white curd like vaginal discharge
- yeasty odour
- dysuria and dyspareunia
37
Explain: Management of Candidiasis (in pregnancy)
Treatment: Clotrimazole most commonly in a vaginal suppository or cream is used for 7 days at night to relieve the maternal symptoms and avoid occurrence of neonatal thrush. Also treat the partner
38
List 4 Bacterial infections and common perinatal complications
Chlamydia
Gonorrhoea
Syphilis
Group B streptococcus (GBS)
Most common perinatal complications associated with bacterial STIs are preterm labour, PROM and LBW babies
39
Explain: Chlamydia in pregnancy and management
Infection rates in pregnancy range from 2-30%.
Diagnosed: First pass U/A
Signs/Symptoms:
asymptomatic (60%), vaginal discharge, abnormal bleeding, abdominal pain, fever, PID
Treatment: erythromycin, clindamycin or single dose azithromycin
Effect on pregnancy:
- Can cause amnionitis and postpartum endometritis
- 70% babies born to mothers with chlamydia become infected
40
Explain: Syphilis in pregnancy and management
Most women who have syphilis have no symptoms.
Diagnosis: Blood test. Syphilis can present as a primary genital ulcer, a rash of secondary syphilis or as a large number of serious conditions as part of tertiary syphilis, if left untreated
Treatment: single dose of 2.4 million units IMI benzyl penicillin
Effect on pregnancy:
- infect fetus
- spontaneous abortion
- preterm birth
- death
- Untreated primary or secondary syphilis in pregnant women causes almost a 100% infection rate in the fetus
41
Explain: GBS in pregnancy and management
is a naturally occurring Gram positive bacteria found in the rectovaginal flora of up to 25% of healthy women.
Treatment: Antibiotics in labour
Effects on pregnancy:
- Asymptomatic bacteriuria
- Intra-amniotic infection
- Endometritis
- Stillbirth
- PROM
- Cultured in a urine sample and UTI
- Wound infections
- Preterm labour/birth
- Spontaneous miscarriage
- Sepsis across the perinatal period
42
List Viral infections
- Human papillomavirus (HPV) types 6 & 11
- Herpes simplex virus HSV-2 (genital herpes)
- Cytomegalovirus (CMV)
- Hepatitis B
- Hepatitis C
- Human Immunodeficiency Virus (HIV)
43
Explain: Human papillomavirus (HPV) and management
Responsible organisms are human wart viruses.
Signs/Symptoms
- most are asymptomatic
- can be transmitted before lesions appear
- Visible warty are fleshy coloured, pale pink or red, raised or flat and small or large
Effect on pregnancy
- In pregnancy warts tend to proliferate and become friable during pregnancy
- during delivery can cause pelvic outlet obstruction and severe haemorrhage related to lacerations of the friable condylomatous tissue.
44
Explain: Genital Herpes (HSV-2) and management
Is a double stranded DNA virus. Is a chronic infection characterised by periods of remissions and exacerbations
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Signs/Symptoms:
May be local or systemic
- Intense pain
- Dysuria
- Occasional itching vaginal discharge
- lymphadenopathy
- Viraemia: fever, headache, nausea, malaise and myalgia
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Treatment:
Aciclovir (Zovirax) therapy continues to be the recommended treatment for HSV during pregnancy, as well as analgesia and topical anaesthetic gels
- Rest and good nutrition are recommedned to reduce possibility of outbreak
Effect on pregnancy:
- PROM increases chance of neonatal herpes
- Pre-existing herepes provides the fetus from infection due to maternal antibodies
45
Explain: Hep B and management
Transmitted by blood and body fluids.
- The organism is extremely hardy and can live outside the body in dried blood or body secretions for up to one week or more
Signs/Symptoms
- Pregnant women with acute hepatitis may be asymptomatic or
- chronic low grade fever,
- anorexia
- fatigue
- skin rashes
46
Explain: HepC and management
Hepatitis C is an RNA virus and is currently the most common bloodborne infection
Sign/Symptoms
- Majority of people are asymptomatic until significant liver damage results
Effect on pregnancy
- Avoid ARM and FSE in labour
- avoid B/F if cracked or bleeding nipples, or if the mother is symptomatic with a high viral load.
47
Explain: Rubella and management
Effect on pregnancy
- When maternal infection/exposure occurs in the first trimester, fetal infection rates are nearly 80% and the risk of miscarriage
- The risk of congenital defects after maternal infection is essentially limited to the first 16 weeks of gestation
- Maternal infection early in pregnancy can lead to fetal death, LBW, deafness, cataracts, jaundice, congenital heart disease, microcephaly and intellectual disability
Treatment: Rubella Vaccination POST delivery
48
Define: DIC
Disseminated Intravascular Coagulopathy
is:
* primarily a thrombotic process
* a systemic process producing both thrombosis and haemorrhage
* also called consumption coagulopathy and defibrination syndrome.
49
Explain: DIC in obstetrics
is always a secondary complication of a condition that initiates coagulation-promoting factors into the maternal circulation.
These conditions include amniotic fluid embolism, placental abruption, missed abortion, retained fetus syndrome, placenta praevia (occasionally), preeclampsia / eclampsia and HELLP syndrome.
50
List DIC risk factors/underlying causes
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Infection
Cancer
Trauma, burns, surgery and snake bite
Pregnancy:
- placental abruption
- major haemorrhage
- pre-eclampsia
- retained dead fetus or placenta
- amniotic fluid embolism
- Placenta praevia
- Preeclampsia
- Eclampsia
- HELLP syndrome
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51
List Warning Signs of DIC
- Profound haemorrhage
- Blood fails to clot
- Petechiae appear
- Bleeding from womans: eye, nose, gums, vagina, venipuncture site, surgical/episiotomy site
- Flank pain
- Abdominal distension
- Hypotension
- Cool skin
- Tachycardia
52
Explain: Management of DIC
- Identify and treat underlying cause
- If actively bleeding: platelet transfusion, fresh frozen plasma
- Use anticoagulants: to block thrombin and secondary fibrinolysis
- Insert indwelling urinary catheter, ideally with a measuring chamber, and monitor urinary output
- Strict monitoring and recording of fluid balance
53
Explain: Toxoplasmosis
Is caused by a paralytic infection typically found in cats whose gut has digested the parasite and excretes it oocytes in their faeces
Acquired through
- Ingestion of undercooked meat
- Not washing hands thoroughly after gardening or cleaning cat litter
- Eating fruit and vegetables that aren't washed
54
Explain: Management of Toxoplasmosis in pregnancy, labour/birth, postnatal
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Complications:
First & Second Trimester Acquired Infection
- Miscarriage
- Congenital hydrocephalus
- Mental retardation
- Deafness or blindness
- Growth problems
Third Trimester Acquired Infection
- Retinochoroiditis develops later
- Stillbirth
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Signs:
- Mostly asymptomatic in healthy women
- Headache
- Sore throat
- Fever
- Fatigue
Antenatal issues:
- Educate on precautionary measures
- If woman has glandular like fever- consider toxoplasmosis and test bloods for: IgV and IgM (immunoglobulins)
- Pos: give Spiramycin
Labour/Birth issues:
- Normal practice
- If any fetal abnormalities consult paed and medical intervention required
Postnatal considerations:
- BF is ok- however check compatibility of drug if being treated for infection before BF
- Baby's born to infected mothers are monitored closely by the paediatrician
55
Explain: Cares and management required for a woman with ASD
Pregnancy issues:
- If treated, problems unlikely
- Specialised cardiac U/S for fetus needed
- Possible cardiac decompensation/ cardiac failure
Labour issues:
- Normal care if treated
- If untreated:
- - anaesthetic r/v prior to labour
- - compression stockings/ anticoagulation considered if immobile
- - 2nd Stage: restricted time frame for active pushing
- 3rd Stage: active management
Postnatal Issues:
- Baby needs cardio screening
- Standard contraception advice
- Encourage ambulation: decrease risk of thromboembolic disease
- follow up with cardiac specialist 6 weeks postpartum
Risks:
- atrial fibrillation
- heart failure
- stroke
56
Explain: Cares and management required for a woman with Complex Hypertension
Pregnancy issues:
- increase surveillance (CTG and U/S)
- aspirin therapy
- U/A at each visit
- PE bloods: FBC, U&E, LFT
- Corticosteroids <34wks
- Psychosocial support
- Individual care plan
- ?admit as in-patient
Labour/Birth issues:
- EDB useful in conjunction w/ antihypertensive thereapy
- AVOID ergometrine, NSAIDs
- Oxytocin should be given slowly
- Hourly BP
- Continuous EFM
Postnatal issues:
- close observations of BP
- Repeat bloods
- Continue meds until BP stable
- Obstetric r/v at 6-8wks
Risks:
- increase risk cardiovascular morbidity, hypertension, ischemic heart disease, stroke, VTE
- Annual BP check recommended
57
Explain: Cares and management required for a woman with Pyelonephritis
Possible indicators:
- UTI signs and symptoms
- dysuria
- haematuria
- bacteriuria (sympomatic)
- severe right flank pain
- costvertebral angle tenderness (CVAT)
- Acute pyelonephritis may present with pyrexia, rigors, abdominal/flank pain, nausea and vomiting
Pregnancy issues:
- U/A for diagnosis
- Obs
- Urgent r/v
- Bloods: cultures, FBC, LFT's, U&E's
- Abx
- CTG
- Pain relief
- Cannulate and Fluids
Labour/Birth issues:
- Possible preterm labour
- - Steroids
- - Cont. EFM
- - Fluids
- UTI/Pyelonephritis in labour:
- - EFM
- - Abx
- - Regular voiding/monitor
- if possible avoid IDC
Postnatal issues:
- Paed r/v and U/S for reflux nephropathy
- GP follow up
- Renal follow up
Risks: Sepsis
58
Explain: Management of UTI in pregnancy, labour/birth and postnatal
Pregnancy
- U/A screen
- Antibiotic therapy
- Risk of LBW and preterm birth if not treated
Labour and Birth
- Antibiotics
- EFM (for tachycardia is mother symptomatic)
- Regular voiding
- Monitor for maternal pyrexia and tachycardia
Postnatal
- neonate r/v for reflux nephropathy
- GP 6wks
