Haematology 3 - Obstetric haematology Flashcards
Haematological changes in pregnancy (red cell mass, plasma volume, WCC, platelet count etc)
Red cell mass imncreases but plasma volume increases more –> dilutional anaemia
Thrombocytopenia
Neutrophilia
Macrocytosis (Can be normal or due to vitB12/Folate deficiency)
Effects of iron deficiency on foetus
IUGR, prematurity, PPH
WHO recommended supplementations in pregnancy
60mg daily iron, 400mcg folic acid from pre-conception until at least 12 weeks gestation
(5mg high dose)
What happens to platelet count and size in pregnancy?
Platelet count drops by~10% and platelets are bigger
Causes of thrombocytopenia in pregnancy?
Gestational ITP Pre-eclampsia HELLP MAHA syndromes
Platelet count cutoffs important in pregnancy
You need >50x10^9/L for delivery
>70x10^9/L for spinal epidural
Why is pregnancy still a hypercoagulable state if there are fewer platelets?
Although there are fewer platelets, the platelets are more aggregable
When does platelet count remit?
2-5 days following delivery
Treatment options for ITP
IVIG, Steroids, anti-D (if RhD +Ve)
MOA of anti-d to treat ITP
The anti-D will coat the RBCs and get cleared by the reticuloendothelial system in preference of the antibodu covered platelets, thus conserving platelet levels
Is the foetus affected in ITP?
The baby may be affected because the IgG antibodies can cross the placenta
Treatment of TTP
Plasma exchange, delivery does not change the course of the disease
What is the leading cause of maternal death in the UK?
PE
What is the state in pregnancy described as?
Hypercoagulable hypofibrinolytic
Which factors are increaed in pregnancy?
Factor 8, vWF, fibrinogen, factor 7, factor 10
Which factors decrease in pregnancy?
Factor XI and protein S
Which leg are most clots in pregnancy in?
Left leg
When is the highest risk of VTE?
Post-partum period (6 weeks post term)
What is the largest predictor of incidence in PE?
High BMI (>25)
O ver which age does the risk of VTE increase?
Increases dramatically >35
What is Virchow’s triad?
Vessel wall
Reduced venous return
Changes in blood coagulation
Prevention of thromboembolic disease in pregnancy
TED stockings + heparin prophylaxis if risk factors
Treatment of thromboembolic disease
LMWH and monitor with anti-Xa levels
When would you stop LMWH prior to delivery?
24 hours after treatment dose, 12 hours after prophylactic dose
