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Haematology (E) > Haematology in Pregnancy > Flashcards

Haematology in Pregnancy Flashcards

1
Q

What are the FBC changes in pregnancy?

A

Mild anaemia
Macrocytosis
Neutrophilia
Thrombocytopenia - increase platelet size

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2
Q

What causes the mild anaemia in pregnancy?

A

Red cell mass rises (120-130%)
Plasma volume rises (150%)
Results in net dilution

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3
Q

How does the iron requirement change in pregnancy?

A

Increases
300mg for foetus
500mg for maternal increased red cell mass
Increase in daily iron absorption in gut (1-2 - 6mg)

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4
Q

What happens to folate requirement in pregnancy?

A

Increases
Growth and cell division
Approximately additional 200mcg/day

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5
Q

What are the complications of iron deficiency in pregnancy?

A

IUGR
Prematurity
Postpartum haemorrhage

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6
Q

What is the recommended advice for folic acid supplementation?

A

Supplement before conception and for >12 weeks gestation

Dose 400ug/day

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7
Q

What is considered anaemia at different stages of pregnancy?

A

1st trimester Hb<110g/l
2nd/3rd trimster Hb<105g/L
postpartum Hb<100g/l

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8
Q

What is the platelet change in pregnancy?

A

Falls, increase in size
Non pregnant: 225-249 x10^9/L
Pregnant: 175-199x10^9/L

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9
Q

What are some pathological causes of thrombocytopenia in pregnancy?

A

Pre-eclampsia
Immune thrombocytopenia (ITP)
Microangiopathic syndromes
All other causes: bone marrow failure, leukaemia, hypersplenism, DIC etc

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10
Q

What are the platelet requirements for delivery?

A

• >50x10^9/l sufficient for delivery (>70 for epidural)

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11
Q

When does platelet count being to rise post partum?

A

D2-5

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12
Q

What are the features of thrombocytopenia in preeclampsia?

A

50% pre-eclampsia get thrombocytopenia
Probably due to increased activation and consumption
Associated with coagulation activation
Usually remits following delivery

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13
Q

What are the treatment options for immune thrombocytopenia in pregnancy?

A

IV immunoglobulin

Steroids

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14
Q

How may the baby be affected by ITP in pregnancy?

A 
Unpredictable (platelets <20 in 5%)
Check cord blood and then daily
May fall for 5 days after delivery
Bleeding in 25% of severely affected (IVIG if low)
Usually normal delivery
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15
Q

What would be avoided in women with ITP due to the risk of low platelets in the foetus?

A

Instrumental delivery

Invasive monitoring

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16
Q

What characterises the microangiopathic syndromes in pregnancy?

A

Microangiopathic haemolytic anaemia (MAHA)
Deposition of platelets in small blood vessels
Thrombocytopenia
Fragmentation and destruction of rbc within vasculature
Organ damage (kidney, CNA, placenta)

17
Q

What changes occur to coagulation factors in pregnancy?

A 
Factor VIII and vWF increase 3-5 fold
Fibrinogen increase 2 fold
Factor VII increase 0.5 fold
Protein S falls to half basal
PAI-1 increase 5 fold
PAI-2 produced by placenta
18
Q

What is the net effect of coagulation changes in pregnancy?

A 
Procoagulant state
Increased thrombin generation
Increased fibrin cleavage
Reduced fibrinolysis
Interact with other maternal factors
19
Q

What is the leading cause of maternal mortality?

A

VTE

20
Q

What is the incidence of thrombosis in pregnancy?

A

1 per 1000 <35 years

2 per 1000 >35 years

21
Q

What thrombosis related investigations can be used in pregnancy?

A

Doppler and VQ are safe to perform in pregnancy

D-dimer is often elevated in pregnancy so not useful for exclusion of thrombosis

22
Q

What additional factors may increase the risk of VTE in pregnancy?

A 
Hyperemesis/dehydration
Bed rest
Obesity
Pre-eclampsia
Operative delivery
Previous thrombosis
Age
Parity
Multiple pregnancy
IVF - ovarian hyperstimulation
23
Q

What is used for prevention of thromboembolic disease in pregnancy?

A

Women with risk factors should receive prophylactic heparin + TED stockings
Mobilise early
Maintain hydration

24
Q

What is the treatment of thromboembolic disease in pregnancy?

A

LMWH as for non-pregnant (does not cross the placenta)
After 1st trimester monitor anti Xa
Stop for labour of planned delivery, especially for epidural

25
Q

What drug to treat thromboembolic disease cannot be used in pregnancy

A

Warfarin - crosses placenta

26
Q

What can occur giving warfarin in first trimester?

A 
Chondrodysplasia puncta
Abnormal cartilage and bone formation
Early fusion of epiphyses
Nasal hypoplasia
Short stature
Asplenia
Deafness
Seizures
27
Q

What obstetric complications can be associated with antiphospholipid sydndrome?

A

Recurrent miscarriage
Three or more consecutive miscarriages before 10 weeks gestation, one or more morphologiacally normal foetal loss after 10th week of gestation, one or more preterm births before 34th week of gestation owing to placental disease

28
Q

What are the most common causes of fatal bleeding in pregnancy?

A

Placenta praevia

Placenta accreta

29
Q

What defines post partum haemorrhage?

A

> 500ml blood loss

30
Q

What are the mechanisms of post partum haemorrhage?

A

Major factors: uterine atony, trauma
Haematological factors minor except: dilutional coagulopathy after resuscitation, DIC in abruption, amniotic fluid embolism etc

31
Q

What factors can precipitate disseminated Intravascular Coagulation?

A 
Amniotic fluid embolism
Abruptio placentae
Retained dead foetus
Preeclampsia (severe)
Sepsis
32
Q

What are the options if there is suspected haemoglobinopathy of the foetus?

A

Proceed
Prenatal diagnosis: CVS sampling 10-12 weeks, amniocentesis 15-17 weeks, fetal blood sampling
Ultrasound for hydrops

33
Q

What are the FBC results for iron deficiency?

A 
Hb: normal or decreased
MCH: low (in proportion to Hb)
MCHC: low
RDW: increased
RBC: low or normla
Electrophoresis: normal
34
Q

What are the FBC results for thalassaemia trait?

A 
Hb: normal
MCH: lower for same Hb
MCHC: relatively preserved
RDW: normal
RBC: increased
Hb electrophoresis: HbA2 increased in beta-thal trait, normal in alpha-thal trait

Haematology (E) (14 decks)

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