Haemoglobinopathies in Pregnancy

Question 1

What should be done in sickle cell patients 3 months before conception?

Answer 1

1. Stop hydroxycarbamide/hydroxyurea

2. Screen partner for sickle cell

Question 2

Which vaccines are offered to sickle cell mothers?

Answer 2

Annual influenza, hepatitis B, Hib, meningococcal, penumococcal.

Question 3

What are the maternal and foetal complications of sickle cell anaemia?

Answer 3

1. Acute painful crisis, pre-eclampsia, thrombosis.

2. Miscarriage, IUGR, preterm labour, death

Question 4

What are the crisis triggers in sickle cell anaemia to avoid in pregnancy?

Answer 4

Cold, hypoxia, dehydration (vomiting), stress, over-exertion.

Question 5

What is the treatment for sickle cell anaemia in pregnancy?

Answer 5

1. Penicillin V continued, folic acid 5mg/day throughout
2. 75mg aspirin from 12/40 for pre-eclampsia prophylaxis
3. If admitted, LMWH prophylaxis

Question 6

What are the consequences of beta thalassaemia major and minor?

Answer 6

1. Chronic haemolytic anaemia, multiple therapeutic transfusions lead to iron overload
2. Mild anaemia (little illness)

Question 7

What is the treatment for thalassaemia in pregnancy?

Answer 7

Wait until 2nd trimester to give deferoxamine (chelation is teratogenic)