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Year 5 path SW > Haematology 11: Obstetric Haematology > Flashcards

Haematology 11: Obstetric Haematology Flashcards

1
Q

Why are pregnant women anaemic despite an average Red cell mass increase of 120-130% ?

A

Plasma volume increases by 150% causing a net dilution

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2
Q

What is the WHO recommended daily Iron and folate supplementation for pregnant women ?

A

60mg iron

400mcg folate

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3
Q

What are pregnant women with thrombocytopenia at risk of when receiving epidural anaesthesia?

A

Spinal haematoma

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4
Q

What happens to platelets in pregnancy ?

A

They become larger

They are sometimes counted as RBCs by the FBC machine

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5
Q

List 4 causes of thrombocytopenia in pregnancy ?

A

Gestational thrombocytopenia (physiological)
Placenta praevia
ITP
MAHA

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6
Q

List 4 causes of MAHA ?

A

TTP- thrombotic Thrombocytopaenia purpura
HUS- Haemolytic uraemic syndrome
HELLP - haemolysis elevated liver enzymes and low platelets
Pre eclampsia

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7
Q

Why does pregnancy induce a net procoagulant state ?

A

To rapidly control bleeding at the placental site after delivery

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8
Q

Which anticoagulant factor falls to half the normal level during pregnancy ?

A

Protein S

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9
Q

Which coagulation factors increase the most during pregnancy ?

A

Factor VIII and vWF (3-5 fold)

Other factors that increase: Fibrinogen (2 fold) and factor VII (0.5 fold)

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10
Q

Which antifibrolytic factors increase during pregnancy ?

A

PAI-1 and 2

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11
Q

Which antifibrinolytic factor is produced by the placenta during pregnancy ?

A

PAI-2

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12
Q

During pregnancy the body assumes a ……….coagulant and ………… fibrinolytic state

A

Hypercoagulant

Hypofibrinolytic

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13
Q

Is D-dimer useful for exclusion of DVT in pregnancy ?

A

No

D-dimer is physiologically elevated in pregnancy

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14
Q

Which autoantibody is present in APLS ?

A

Anti-cardiolipin antibodies

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15
Q

Which 2 medications are recommended in APLS ?

A

LMWH + aspirin

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16
Q

Give 3 indications for testing for APLS ?

A
  • 3 or more consecutive miscarriages <10 weeks gestation
  • 1 morphological normal foetal loss > 10 weeks gestation
  • 1 or more preterm births before 34 weeks gestation thought to be due to placental disease
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17
Q

What is placenta accreta ?

A

When the placenta goes through the endometrial lining (becomes difficult to deliver)

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18
Q

What is placenta increta ?

A

The placenta goes through the uterine wall

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19
Q

What is placenta percreta ?

A

Placenta goes through the uterine wall and attaches to other organs

20
Q

What is a risk factor for placenta accreta ?

A

Previous C section

21
Q

What is a complication of placenta accreta ?

A

PPH/ MOH

22
Q

Define post partum haemorrhage (PPH) ?

A

> 500ml blood loss in the first 24 hours of pregnancy

23
Q

What are the 4Ts of causes of PPH ?

A

Tone - uterine atony
Tissue- placenta accreta
Trauma- instrumental delivery
Thrombin- DIC

24
Q

How does amniotic fluid embolism present ?

A

Sudden onset shivers, vomiting, shock and DIC

25
Q

Which modality is used to diagnose haemoglobin variants ?

A

HPLC (high power liquid chromatography)

26
Q

Elevated HbA2 >3.5% suggests which thalassaemia ?

A

Beta thalassaemia

27
Q

How are pregnant women with sickle cell disease managed ?

A

Top up or exchange red cell transfusions
prophylactic transfusions
Alloimmunisation (make sure the blood is matched)

28
Q

3 blood changes in pregnancy

A

mild anaemia - RBC mass rises, plasma volume rises, net dilution
macrocytosis
neutrophilia
thrombocytopaenia

29
Q

when should a pregnant lady take folate

A

from before conception to > 12 weeks gestation

30
Q

what platelet counts are sufficient for delivery/pidural

A

delivery > 50x109/L

epidural >70x109/L

31
Q

treatment for ITP

A

IVIG
steroids
anti-D where RhD +ve

32
Q

what happens in MAHA in pregnancy

A

deposition of platelet-rich thrombin in small BV
- shearing of RBC - haemolytic anaemia
thrombocytopenia
organ damage (kidney, CNS, placenta)

33
Q

treatment for TTP

A

delivery does not affect the course of TTP or HUS

plasma exchange

34
Q

when do most PE deaths occur in pregnancy

A

40-46 weeks

35
Q

what investigations are safe in pregnancy for thrombosis

A

dopplet and VQ scans

36
Q

what factors increase the risk of thrombosis in pregnancy

A

all - changes in blood coagulation, reduced venous return, vessel wall

variable - hypremesis/dehydration, bed rest, obesity, pre-eclampsia. operative delivery, previous thrombosis/thrombophilia, age over 35, parity, other medical problems, IVF (ovarian hyperstimulation)

37
Q

prevention of thromboembolic disease in pregnancy

A

prophylactic heparin + TEDs
mobilise
hydration
high risk - LMWH

38
Q

treatment for thromboembolic disease in pregnancy

A

LMWH
do not use warfarin as teratogenic
stop anticoagulation before delivery

39
Q

when can an epidural be given post heparin

A

24 hrs after treatment dose

12 hrs after prophylactic dose

40
Q

effects of thrombophilia on the pregnancy

A 
associated with impaired placental circulation 
IUGR
recurrent miscarriage 
late foetal loss
abrupto placenta
severe pre-eclampsia toxaemia
41
Q

define placenta accreta, increta, percreta

A

accreta - goes trhough endometrial lining
increta - through uterine wall
percreta - through uterine wall and sticks to other organs

42
Q

three things we screen for in terms of haemoglobinopathies

A

alpha-0-thalassaemia - death in utero
beta- 0 -thalassaemia - transfusion dependent
HbSS - 43 yr LE

43
Q

counselling about haemoglobinopathies

A 
all important ones are recessive 
test partner 
oprions: 
proceed
prenatal diagnosis - CVS sampling, amniocentesis, Us for hydrops
44
Q

complications of SCD in pregnancy

A 
foetal GR 
miscarriage 
preterm labour
pre-eclampsia
venous thrombosis
45
Q

management of SCD in pregnancy

A

RBC transfusion
prophylactic transfusion
alloimmunisation

46
Q

iron deficiency vs thalassaemia trait

A 
iron def:
Hb normal/low
MCH low
MCHC low
RDW high 
RC low/normal 
Hb electrophoresis normal 
thalassameia trait:
Hb normal 
MCH low
MCHC preserved
RDW normal 
RBC high 
Hb electrophoresis Hb A1c high in B that, normal in a thal trait

Year 5 path SW (106 decks)

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