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Case 8 > Haematology In Pregnancy > Flashcards

Haematology In Pregnancy Flashcards

1
Q

What are reticulocytes?

A

Immature red blood cells.

They are a marker for red blood cell turnover

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2
Q

What is the composition of blood?

A
  • Red blood cells (1/3)
  • -> circles in microscopy
  • White blood cells
  • -> big purple cells
  • Plasma (2/3) = water, salts, enzymes, globulins, proteins, clotting factors.
    —> small circles microscopy

When centrifuging, RBCs are on the bottom, WBCs are next and plasma is on the top

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3
Q

What is a low RBC (Hb) count called?

A

Anaemia

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4
Q

What is a high RBC (Hb) count called?

A

Polycythaemia

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5
Q

How does plasma volume and RBC mass change in pregnancy?

A

Plasma volume increases and hits roughly 2600ml whereby there is a plateau for the last 8 weeks

RBC mass increases
- erythropoietin rises in first trimester - it is a hormone released from the kidneys that increases RBC production from bone marrow cells (myeloid progenitors)

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6
Q

Is anaemia normal in pregnancy?

A

Yes as physiological anaemia.

Hb normally stays above 11.5g/dL (115g/L) threshold. However, Hb levels can dip to well below this during 20-24 weeks

Below 12g/dL = iron deficiency

Below 10.5g/dL = anaemia

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7
Q

What happens to RBC mass post-partum?

A
  • Declines due to bleeding (haemorrhage)

Normal non-pregnant Hb (RBC) levels are reached at 3 weeks pp

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8
Q

Why is Iron in pregnancy important and what are the sources of it?

A

Important to prevent anaemia in pregnancy and in normal person

Sources

  • organic (Fe2+) - red meat
  • inorganic (Fe3+) - nuts, eggs, veg

Iron is needed for Hb function as it has a binding site
- stored in liver as ferritin and released to circulation where it travels to bone marrow for Hb synthesis.

  • stored in bone marrow as haemosiderin
  • iron is recycled as bilirubin after RBC breakdown as
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9
Q

Iron storage

A

Liver = ferritin
- Norma is 15mcg/L

Bone marrow = haemosiderin

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10
Q

Iron requirements

A

Adult male: 1mg/day

Menstruating female: 2mg/day

Pregnant female: 4-7mg/day
- needed for placenta, foetus, and for RBC to increase

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11
Q

Iron deficiency

A
  • Hb <105g/L
  • MCV = mean cell volume (overall cell size)
    —> MCV increases up to 105fl in pregnancy due to increased iron
  • Serum ferritin <15mcg/L
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12
Q

Treatment of iron deficiency

A

Iron oral supplements

- no advantage to IV iron (IV is last resort as there’s anaphylaxis risk)

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13
Q

Side effects of iron supplements

A

Nausea
Abdo pain
Toilet problems

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14
Q

Why are B12 and folate important in pregnancy?

A

They are both important for DNA synthesis

B12 - meat fish + dairy

  • no increase in pregnancy (can be decreased)
  • stores last for 4 years

Folic acid - NEURAL TUBE DEVELOPMENT

  • normal requirement = 100ug/day
  • pregnancy requirement = 300-400ug/day
  • stores last 3 months
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15
Q

What increases risk of folate deficiency?

A
  • Hyperemesis (extreme sickness)

- Twin pregnancy

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16
Q

What is the 2 extremes of platelet levels?

A

Too many = thrombocytosis (>500x10^9/L)

Too few = thrombocytopenia (<100x10^9/L)

17
Q

What cells make RBCs, WBCs and platelets?

A

In bone marrow

Myeloid precursors —> white blood cells

Erythroid precursors —> red blood cells

Megakaryocytes —> platelets

18
Q

Why does thrombocytopenia occur in pregnancy?

A

Because there is increased consumption of platelets which leads to more megakaryocytes (to replace them)

Caused by

  • HELLP (haemolysis, elevated liver enzymes, low platelet number)
  • Pre-eclampsia
  • Gestational thrombocytopenia
19
Q

What causes thrombocytopenia generally (non-pregnant)?

A
  • autoimmunity (antibodies against platelets)
  • sepsis
  • haemorrhage
  • cardiac bypass surgery (bypass machines consume platelets as they can’t get past filter)
  • hypersplenism
20
Q

Gestational thrombocytopenia

A

Benign and not serious

  • causes of 75% of all thrombocytopenia at term
  • platelets are >70x10^9/L
  • count recovers within 2 months of delivery
21
Q

Serious thrombocytopenia

A
  • when you see BLOOD FRAGMENTS ON A BLOOD FILM

caused by:

  • pre-eclampsia
  • HELLP
  • haemorrhage
  • amniotic embolism
22
Q

What does platelet clumping on a blood film indicate?

A

Thrombocytopenia

  • Immune thrombocytopenia
  • familial thrombocytopenia
  • pseudo thrombocytopenia
  • Bone marrow infiltration
  • hypersplenism
23
Q

What causes Venous thromboembolism? (Virchow’s triangle)

A
  • more pro-coagulant
  • less anticoagulant
  • reduced fibrinolysis (breakdown of fibrin in clots)
  • endothelial damage
  • placental separation
  • surgery
  • venous stasis (slow flow)
  • venous distension (bulging)
  • compression of external iliac vein
24
Q

What is the most common cause of venous thromboembolism?

A

DVT

90% are on the left side and proximal as the left common iliac vein is susceptible to compression from the overlying right common iliac artery

Pregnancy exacerbates the compression because of baby -> always lie on left hand side

Case 8 (6 decks)

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