Maternal Diseases: Hematologic Disorders Flashcards
What are some hemotaologic disorder examples? 3
- Rh isoimmunization
- Sickle cell anemia
- Heterozygous thalassemia
Rh isoimmunizartion is a hematologist disease of what?
Newborns
What disease does Rh isoimmunization typically lead to?
Eryhtroblastosis fetalis
How does RH isoimmunization happen? 2
- Mom (Rh-) develops antibodies to surface antigens on fetal (Rh+) red blood cells
- Mom’s antibodies attack and destroy fetal red blood cell
What is erythroblastosis fetalis?
Rapid destruction of fetal red blood cells
What happens as a result of erythroblastosis fetalis? 2
- Outpouring of many new blood cells to compensate for the RBC destruction
- The immature RBCs do not support or carry oxygen well
When is RH isoimmunization usually prevalent?
Only in 2nd and subsequent pregnancies
Why is RH isoimmunization on the decline?
Because of the introduction of preventative maternal immunologic blocking treatments
What are some complications of RH isoimmunization? 5
- Hepatosplenomegaly
- Jaundice
- Kernicterus
- Congestive heart failure
- Edema
What is kernicterus?
Bilirubin in fetal blood destroys brain and spinal cord tissues
What is the most severe form of RH isoimmunization? And what does it look like?
- When RH isoimmunization becomes immune hydrops fetalis.
- Fluid overload seen as pleural effusion and ascites in the fetus
What is the maternal management of RH isoimmunization?
Rh- mothers will be given an injection of Rh immunoglobulin (WinRho or RhoGam) in first pregnancy at 28-32 weeks and again after delivery (within 72 hours)
What does the RH immunoglobulin injections do for RH isoimmunization?
It will prevent the formation of antibodies in the mother
What are some other indications for administering WinRho in the RH- patients? 4
- Spontaneous abortion (72 hours)
- Therapeutic abortion
- Ectopic pregnancy after aminocentesis
- Maternal hemorrhage, vaginal bleeding in pregnancy
Should we give an injection to a RH+ mother?
Never
What is the fetal assessment for Hemolytic disease?
BPP and Biometry in fetal assessment units
When we assess for anemia, what does it look like sonographically? 2
- Ascites appears first as echogenic bowel
- Pleural effusion/ pericardial effusion
When we do doppler of the MCA what do we see? 3 (What do we measure? >1.5 MoM means what? what do we need to do?)
- Peak velocity of the MCA is measured
- > 1.5 multiples of median (MoM) would indicate severe anemia in the fetus
- Fetal blood transfusion would be required
What are some things we do in sonography for hemolytic diseases? 3
- Fetal assessment
- Assessing for anemia
- Doppler of the MCA is performed
How does someone get sickle cell anemia?
It is an inherited disorder
Which demographic of individuals is most affected by sickle cell anemia? 2
- People of African descent
- Can also affect those central/ South America, Caribbean islands, Mediterranean countries, India and Saudi Arabia
What does sickle cell blood cells look like?
Sickle shaped
What is the disadvantage of sickle cell anemia?
Poor fit in capillaries and small vessels resulting in anemia
What are some possible complications of sickle cell anemia? 2
- Maternal death
- Spontaneous abortion
How common is heterozygous thalassemia?
It is one of the most common autosomal recessive genetic abnormalities associated with pregnancy
Where does heterozygous thalassemia occur? What does it do?
The mutation occurs on the same gene as sickle cell and reduces hemoglobin production
What does heterozygous thalassemia result in? 2
- Anemia
- Can lead to non- immune hydrops and death
