Haematological Problems in Pregnancy Flashcards
How does the definition of anaemia change throughout pregnancy?
Definition – low haemoglobin, very common in pregnancy
First trimester < 110g/l
Second or third trimester < 105g/l
Postpartum < 100g/l
What are the risk factors for anaemia during pregnancy?
Haemoglobinopathies such as sickle cell or thalassaemia’s Increasing maternal age Low socioeconomic status Poor diet Previous anaemia during pregnancy
How does anaemia present during pregnancy?
Dizziness, fatigue and dyspnoea (but all also normal in pregnancy)
Asymptomatic
Pallor
Koilonychia (spoon shaped)
Angular cheilitis (ulceration at the corner of the mouth)
How does the MCV value change the likely cause of anaemia?
Microcytic <76
Iron deficiency
Thalassaemia
Sideroblastic anaemia
Normocytic 76-96 Anaemia of chronic disease Marrow infiltration Haemolytic anaemia Chronic kidney disease
Macrocytic >96 B12/folate deficiency Alcohol consumption Recticulocytosis Hypothyroidism
How is anaemia investigated in pregnancy?
Full Bloods count
Hemoglobinopathy screening
Haemoglobin electrophoresis
Folate levels
Ferritin (decreased in iron deficiency anaemia)
All women in UK screening at booking and 28 weeks for anaemia
How should anaemia be managed in pregnancy?
If micro or normocytic then iron deficiency most likely so trial oral iron 100-200mg – drink with a glass of orange juice. Assess FBC 2 weeks later looking for an increase of 10g/l/week
Parental iron infusion if compliance poor and evidence of malabsorption
Folate supplementation if this is the cause
Beta thal and Sickle cell – folate and iron supplementation.
What are the risks of Sickle cell disease during pregnancy?
Autosomal recessive disease
Crisis are more common in pregnancy; it also increases the risk of PET and delivery by CS due to foetal distress. Anaemia at even higher risk.
What extra precautions should be taken for sickle cell disease during pregnancy?
Screening of the father in case prenatal diagnosis needs to be made.
Folate 5mg/day, 75mg aspirin daily from 12 weeks and stop any NSAIDS
Avoid pethidine as it induces fits
Screen for urine infections every visit
Regularly assess foetal growth – growth pathway
Be wary of iron overload
Check vaccine status
How should sickle cell disease be managed during delivery and postnataly?
Aim for vaginal delivery with continuous foetal monitoring
Consider antenatal thromboprophylaxis and postnatal thromboprophylaxis (7 days if vaginal 6 weeks if CS)
What are the 4 different Alpha thalassaemia types?
Alpha thal trait (alpha0 or alpha+) – usually asymptomatic 1 or 2 defective alleles
HbH – chronic haemolysis causes iron overload – 3 defective alleles
Hb Barts – no functional alpha alleles – incompatible with life foetus will be Hydropic and born early.
Severe early onset PET often complicates these pregnancies
Which conditions is specifically associated with thalassaemias during pregnancy?
Severe early onset PET often complicates these pregnancies
What are the 2 different Beta thalassaemia types?
Beta thal trait – one defective allele – often asymptomatic
Beta thal major – transfusion dependant – issues with iron overload
How should thalassaemia me managed during pregnancy?
Check Ferritin
Folate 5mg/day
Screening of partner
How can hemophilia affect pregnancy?
Haemophilia – X-linked recessive
Carrier mothers are asymptomatic but may have half as much clotting factors
Increased risk of PPH so TXA given for 5 days. Must check clotting factors aiming for >50IU/L. Send FBC, clotting screen and group and save when in labour.
How does von willebrand’s disease effect pregnancy?
VWD both AD and AR types
Normally stabilises factor VIII and helps platelet adherence.
Levels of vWF and Factor VIII normally rise during pregnancy but fall rapidly post-partum so major risk of PPH.
Desmopressin can be used in some cases to stimulate vWF release.
