haematology - obstetric haematology

Question 1

haematological changes in pregnancy

Answer 1

↑↑ plasma volume
 ↑  red cell mass
 ↑  MCV
 ↑  WCC
 ↑  factors VII, VIII, IX, X, XII

 ↓  haemoglobin
 ↓  haematocrit
 ↓  platelets
 ↓  factor XI
 ↓  protein S

Question 2

HEELP syndrome

Answer 2

life threatening complication associated with pregnancy

haemolysis
elevated liver enzymes
low platelets

Question 3

key features of HEELP syndrome

Answer 3

MAHA
normal APTT/PT
↑↑ AST
↑↑ ALT
 ↓  platelets

Question 4

differentials of HEELP

Answer 4

DIC (↑ APTT/PT, ↓ fibrinogen)

AFLP (marked transaminitis)

Question 5

haemolytic disease of the newborn (HDN)

Answer 5

high maternal red cell antibody levels can destroy metal red cells if they have corresponding red cell antigen

Question 6

how might a person form red cell antibodies

Answer 6

blood transfusion

metal cells entering maternal circulation during pregnancy/delivery

Question 7

which antibody can cross the placenta

Answer 7

IgG

Question 8

which antibody is most often responsible for HDN

Answer 8

anti-D

always transfuse RhD- blood to RhD- women of childbearing age

Question 9

prevention of anti-D formation

Answer 9

IM anti-D Ig if high risk of feto-maternal haemorrhage

• routine at 28 and 34 weeks
• during sensitising events
• at delivery if baby is RhD+