Lecture 2020: Hematologic Consequences of pregnancy

Question 1

Prevalence of anemia in pregnancy by trimester:

Answer 1

1st: 8%
2nd: 12%
3rd: 34%

Question 2

At term, what would be considered a pathologically low hgb?

Answer 2

<9

Question 3

Good dose of iron for iron deficiency in pregnancy?

Answer 3

15-30mg elemental iron per day

Question 4

If iron deficient and can’t tolerate oral iron - what should be given to pregant woman?

Answer 4

LMW iron dextran 1g over 1 hour OR

ferric carboxymaltose 750mg on two consecutive visits

Question 5

Recommendations for folate in pregnancy?

Answer 5

400 ug per day

Question 6

Aplastic anemia sometimes precipitated by pregnancy. How is it managed?

Answer 6

• transfuse to maintaing PLT >20 and hgb >8
• growth factor for ANC <500
• cyclosporine sometimes

Question 7

Management of sickle cell in pregnancy?

Answer 7

• folate 5mg daily
• stop iron chelation, hydroxyurea, ACE-I/ARB
• no iron-containing prenatal unless they are deficient
• attempt to maintain pre-pregnancy hgb level

Question 8

When should allo-antibodies be tested during pregnancy for those mothers with sickle cell?

Answer 8

• day 1
• week 24
• prior to delivery

Question 9

VTE ppx in sickle cell in the context of pregnancy?

Answer 9

• Antepartum and post-partum VTE ppx if any history of VTE’s

- Post-partum VTE ppx for 6 weeks if HBSS and/or moderate-to-severe SCD history

Question 10

How to treat gestational thrombocytopenia?

Answer 10

Don’t treat it. Usually happens in 2nd or 3rd trimester. Dx of exclusion. Will NOT affect fetal outcomes.

Question 11

What are the indications to treat ITP in pregnancy?

Answer 11

• PLT <20
• symptomatic
• procedure

Question 12

Treatment options in ITP in pregnancy?

Answer 12

• Prednisone or IVIG are first line
• Anti-D has case reports
• Rituximab and TPO agonists are Category C in pregnancy
• MUST MONITOR infant for thrombocytopenia in 1st week of life

Question 13

Prevalence of TTP in pregnancy?

Answer 13

10-30% of all adult TTP is obstetric, 7% in pregnancy itself

Question 14

Treatment of TTP in pregnancy?

Answer 14

• Delivery and supportive care preferred
• Plasma exchange is effective
• not clear if steroids work

Question 15

Things that can lead to DIC in pregnancy?

Answer 15

• amniotic fluid embolism, retained dead fetus, abruptio placenta
• Severe preeclampsia or HELLP can also lead to DIC

Question 16

Management of DIC in pregnancy?

Answer 16

delivery and supportive care preferred. Otherwise PRN transfusions of PLT, FFP, cryo

Question 17

Treatment of antiphospholipid antibody syndrome in pregnancy?

Answer 17

Daily baby ASA at first positive pregnancy test

Question 18

Good treatment for menorrhagia?

Answer 18

mirena device is good first line
tranexamic acid good possible 2nd line
NSAIDS more of a 3rd line option

Both traexamic acid and NSAIDS are taken during the time of bleeding period