Heme complications of pregnancy

Question 1

Gestational thrombocytopenia features - 1) plt count 2) when it’s more common

Answer 1

Mild (100-150K) + more common as gestation progresses + no other CBC abnormalities + no increased bleeding or bruising

Question 2

ITP in pregnancy clinical features

Answer 2

*Thrombocytopenia <100k in pregnancy without other CBC abnormalities is typically ITP

Question 3

Most common cause of thrombocytopenia during 1st and 2nd/3rd trimesters

Answer 3

ITP in 1st
gestational thrombocytopenia in 2nd and 3rd

Question 4

Goal platelet count for ITP in pregnancy for neuraxial anesthesia

Answer 4

Greater than 70k

Question 5

First line treatment of ITP in pregnancy

Answer 5

• prednisone +/- IVIG
  *pred preffered over dex since dex has placental transmission and can result in adverse effects to fetus

Question 6

TTP management in pregnancy + role of rituximab and caplacizumab

Answer 6

PLEX
Steroids
*Use of rituximab has to be weighed against maternal and fetal risks
*Safety of caplacizumab is unknown so not advised

Question 7

fetal & neonatal alloimmune thrombocytopenia clinical features

Answer 7

• neonate with severe thrombocytopenia and parents with no heme history
  *this is analogous to hemolytic disease of the newborn for platelets (mother lacks HPA-1a antigen that father has, crosses placenta, and destroys fetus’s platelets)

Question 8

Most common antibody in neonatal alloimmune thrombocytopenia

Answer 8

HPA-1a

Question 9

Management of fetal neonatal alloimmune thrombocytopenia

Answer 9

• platelet transfusion if indicated (HPA-selected)
• cranial US to screen for ICH

Question 10

Management of IDA in pregnancy during first trimester

Answer 10

oral iron

Question 10

Ferritin threshold for anemia in pregnancy

Answer 10

<30

Question 11

Peripartum management of LMWH (prophylactic and therapeutic)

Answer 11

Therapeutic lovenox:
Schedule delivery
Discontinue LMWH 24 hours prior
Prophylactic lovenox
Spontaneous labor

Question 12

How long you need to hold LMWH for neuraxial anesthesia (therapeutic and prophylactic)

Answer 12

Need to hold therapeutic LMWH 24 hrs before, prophylactic LMWH 12 hours before

Question 13

Indications for postpartum prophylaxis

Answer 13

• Unprovoked VTE
• estrogen-associated VTE
• ***VTE w/ a non-hormonal temporary risk factor (ASH doesn’t recommend antepartum prophylaxis)

Question 14

Management of pregnant homozygous FVL patient

Answer 14

LMWH prophylaxis during pregnancy and postpartum

Question 15

Obstetric APS prophylaxis

Answer 15

ASA + prophylactic dose LMWH antepartum
- just prophylactic LMWH postpartum
(*risk is higher for pregnancy complications antepartum)

Question 16

Thrombotic APS management during pregnancy

Answer 16

therapeutic LMWH + low dose aspirin antepartum
Therapeutic LMWH postpartum

Question 17

Management of patient with recurrent pregnancy loss & inherited thrombophilia

Answer 17

NO anticoagulation (hasn’t been shown to improve pregnancy outcomes)

Question 18

Steroid of choice in pregnancy

Answer 18

Prednisone (dex crosses the placenta)