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Classical Hematology > Hematology Issues in Pregnancy > Flashcards

Hematology Issues in Pregnancy Flashcards

1
Q

At what platelet count should you consider another diagnosis aside from gestational thrombocytopenia?

A

Less than 100. <1% of GT has a platelet count under 100

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2
Q

Most common cause of thrombocytopenia in the first trimester?

A

ITP

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3
Q

Most common cause of thrombocytopenia (<100k) in the second trimester?

A

ITP

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4
Q

Most common cause of thrombocytopenia <100 in 3rd timester?

A

pre-eclampsia

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5
Q

How to make diagnosis of gestational thrombocytopenia?

A

Diagnosis of exclusion. Mild thrombocytopenia (100-150), no history of TCP outside of pregnancy, no signs of MAHA or coagulopathy. Resolves after delivery

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6
Q

Treatment threshold for ITP in pregnancy?

A

Platelet 20-30 during first 8 months
Approaching delivery: >50 for L&D, >70 for epidural

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7
Q

First line therapy for ITP in pregnancy?

A

Prednisone (avoid dexamethasone)
IVIG

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8
Q

Second line therapy options for ITP (3)

A

TPO agonists
Rituximab
Splenectomy

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9
Q

Diagnostic criteria for Pre-eclampsia

A

> 20 weeks pregnant with:
HTN + Proteinuria and/or endo organ dysfunction

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10
Q

Diagnostic criteria for HELLP

A

Hemolysis (MAHA)
Elevated liver enzymes
Low platelets
Occurs after 20 weeks through early postpartum

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11
Q

Clinical features for acute fatty liver of pregnancy

A

RUQ pain, N/V, jaundice, Rapid onset liver failure
Frequent coagulopathy
Hypoglycemia
Renal failure
Mild-moderate thrombocytopenia, +/- MAHA

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12
Q

Severe TMA presenting prior to 20 weeks should make you think of what two diagnoses?

A

TTP or aHUS
Send ADAMTS13 activity level

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13
Q

Treatment for TTP in pregnancy

A

PLEX and steroids
We don’t know if caplacizumab is safe

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14
Q

What is the most common timing of complement-mediated HUS regarding pregnancy?

A

Most commonly post-partum

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15
Q

Treatment of complement-mediated HUS in pregnancy

A

Eculizumab

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16
Q

You see severe acute kidney injury and a new onset or worsening TMA post-partum. What diagnosis is most likely?

A

CM-HUS

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17
Q

What is the most common antibody seen in fetal and neonatal alloimmune thrombocytopenia?

A

Anti-HPA1a

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18
Q

Treatment for woman with history of fetal and neonatal alloimmune thrombocytopenia?

A

Maternal IVIG +/- steroids

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19
Q

Definition of anemia throughout pregnancy

A

1st trimester: Hb <11
2nd trimester: Hb <10.5
3rd timester: Hb <11

20
Q

Most common disease causing anemia in pregnancy?

A

IDA

21
Q

Threshold for ferritin to diagnose IDA in pregnancy?

A

<30

22
Q

Management of IDA in pregnancy

A

Oral iron if early in pregnancy or mild deficiency
IV iron in 2nd or 3rd trimester

23
Q

What is the mechanism of physiology anemia of pregnancy?

A

Increase in plasma volume

24
Q

Anticoagulant option(s) during pregnancy

A

LMWH and UFH

25
Q

What 4 anticoagulants are safe during breastfeeding?

A

LMWH
UFH
Fondaparinux
Warfarin

26
Q

For those who are on therapeutic LMWH while pregnant, how do you manage anticoagulation for delivery? How do you manage it for neuraxial anesthesia?

A

Hold LMWH 24 hours prior epidural and delivery. Can consider transition to UFH gtt

27
Q

For someone on prophylactic LMWH during pregnancy, how do you manage anticoagulation during delivery or neuraxial anesthesia?

A

Hold 12 hours prior to epidural
Can do spontaneous labor but low certainty of evidence

28
Q

Who should receive both antepartum and postpartum prophylactic anticoagulation?

A

Those with:
history of unprovoked VTE
Estrogen associated VTE

29
Q

What patient population only needs postpartum anticoagulation prophylaxis?

A

VTE associated with a non-hormonal temporary risk factor

30
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of FVL heterozygosity?

A

No meds, only surveillance

31
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of prothrombin gene mutation heterozogosity

A

No meds, surveillance only

32
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of Protein C or S deficiency, and no family history of VTE

A

No meds, only surveillance

33
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of Protein C or S deficiency, but family history of VTE

A

Postpartum prophylaxis only

34
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of Antithrombin deficiency but no family history of VTE

A

No meds, surveillance only

35
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of antithrombin deficiency and a family history of VTE?

A

Antepartum and postpartum prophylaxis

36
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of homozygous Prothrombin gene mutation and no family history of VTE

A

Postpartum only

37
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of homozygous Prothrombin gene mutation and family history of VTE?

A

antepartum and postpartum prophy

38
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of FVL homozygous mutation?

A

Antepartum and postpartum

39
Q

What is the recommended thromboprophylaxis for someone without a personal history of VTE but with a history of multiple thrombophilias (like FVL and PTG2021A)

A

antepartum and postpartum prophy

40
Q

What is the treatment of thrombotic APS in pregnancy? (Antepartum and postpartum)

A

Antepartum: low-dose aspirin + therapeutic LMWH
Postpartum: Therapeutic LMWH (or if on long-term AC, then bridge to warfarin)

41
Q

What is the antepartum and postpartum management of obstetric APS (APS testing+ without thrombosis hx)?

A

Antepartum: Prophylactic LMWH + low dose aspirin
Postpartum: Prophylactic LMWH for 6-12 weeks

42
Q

What are the 4Ts of postpartum hemorrhage?

A

Tone (uterine atony)
Trauma (laceration, uterine rupture)
Tissue (retained placenta)
Thrombin (Coagulopathies)

43
Q

In addition to obstetric interventions, what is a medication option to decrease mortality of postpartum hemorrhage?

A

Antifibrinolytics like TXA

44
Q

What happens to the levels of VWF, Factor VIII, and fibrinogen during prengnacy?

A

They increase, peak at delivery

45
Q

What is the most appropriate pre-conception counseling for a woman on warfarin?

A

Switch to LMWH prior to conception. highest risk of embryopathy between 6-10 weeks

Classical Hematology (15 decks)

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