MODULE 7: Hemolytic Disorder during Pregnancy Flashcards
Most common hematologic problem is
Physiologic anemia
Abnormally low number of circulating red blood cells or level of hemoglobin, or both, resulting in diminished oxygen - carrying capacity
Anemia
Indicates inadequate levels of hemoglobin (Hb) in the blood
Anemia
During pregnancy, it is defined as hemoglobin less than 10g / dl
Anemia
Signs and symptoms of anemia
a. Pallor
b. Tissue hypoxia
c. Weakness
d. Fatigue
e. Tachycardia / palpitations
How many regions in the Philippines has a high change of anemia in pregnancy
12 / 16 regions
Highest prevalence rate of infants and preschoolers who have anemia
Marikina and Pasig
Marikina and Pasig prevalence rates is followed by
Quezon City and Pasay city
Pregnant women has a chance to have anemia in pregnancy of
58.4%
Lactating women has a chance to have anemia in pregnancy of
68.5%
Iron Deficiency Anemia
a. Most common anemia in pregnancy
b. Microcytic anemia
c. Decreased Mean Corpuscular Volume
d. Due to increased requirement in iron of fetus
e. Take supplementation; ferrous sulfate and iron supplements as soon as pregnancy is diagnosed
f. Inadequate iron intake resulting in hemoglobin levels below 11g / dl
g. Characterized by microcytic, hypochromic RBC
h. Microcytic - small rbc
i. Hypochromic - less color rbc
Risk factors of Iron Deficiency Anemia
a. Diet low in iron
b. Heavy menstrual period
c. Unwise weight - reducing programs
d. Pregnant with less than 2 years interval from previous pregnancy
e. Low socioeconomic status
Diet low in iron
Poor nutrition
Heavy menstrual period
Loses significant amount of iron
Unwise weight - reducing programs
Diet
Pregnant with less than 2 years interval from previous pregnancy
Needs recovery
Low socioeconomic status
a. Not able to intake iron supplements and ferrous sulfate
b. Not able to eat properly
Assessment: Iron Deficiency Anemia
a. < 30 mg/ dl serum iron
b. > 400 mg/dl iron binding capacity
c. Extreme fatigue
d. Poor exercise tolerance
e. Pale skin
f. Unusual cravings
Extreme Fatigue
Tissue Hypoxia
Pale Skin
a. brittle nails
b. pallor
Unusual cravings
PICA
Effects of IDA to Mother
a. Fatigue
b. Susceptible to infection
c. Increase chance of preeclampsia, eclampsia and postpartal Hemorrhage
d. Delayed healing of episiotomy or incision
Effects of IDA to Fetus
a. Risk of low weight
b. Prematurity
c. Stillbirth
d. Severe iron deficiency anemia
e. Fetus - hypoxic during labor
Fetus - hypoxic during labor
Due to impaired uteroplacental oxygenation
Medical Management Administration in IDA
a. Prenatal Iron supplements of 60 mg at least 6 months once daily
b. Iron supplementation should continue more than 6 months once daily during postpartum period if in a certain area prevalence of anemia
Nursing Management for IDA
a. Inform patient diet rich in iron and vitamins
b. Take iron supplement orange juice or Vitamin C supplement
c. Eat foods with fiber
d. Provide rest every after activity
e. Practice hand washing
Insufficient folic acid or vitamin B9 leads to
Folic Acid Deficiency Anemia
Folic acid or vitamin B9
Normal formation of red blood cells
Insufficient folic acid is associated with
Neural tube defects
The second most common anemia in pregnancy
Folic Acid Deficiency Anemia
Most common cause of megaloblastic anemia in pregnancy
Folic acid deficiency anemia
Absent of makes RBC Immature RBCs failure to divide, becomes enlarged and are fewer in numbers
Folic acid (folacin)
FDA
a. Increased Mean Corpuscular Volume
b. Slow in progression
c. Takes several weeks to have folic acid deficiency anemia which then specifically in 2nd trimester you may see the symptoms
Risk factors of FDA
a. Multiple pregnancy
b. History of hydantoin ingestion
c. History of oral contraceptives
d. Poor nutrition
e. Alcohol abuse
f. Patient with poor gastric absorption
Multiple pregnancy
Causes increased in fetal demand of folic acid
History of hydantoin ingestion
a. Anti-convulsive drug
b. Interferes with folic absorption
Patient with poor gastric absorption
a. obese
b. gastric bypass
Assessment of FDA
a. Decreased appetite
b. Irritable
c. Pale skin
d. Diarrhea
e. Extreme fatigue
Effects of FDA to mother
a. Increase risk of having blood transfusion following birth due to anemia
b. Increased risk of hemorrhage due to thrombocytopenia
c. Susceptible to infection
Increase risk of having blood transfusion following birth due to anemia
Due to immature / insufficient number of RBC
Effects of FDA to fetus
Increased risk of neural tube defects
Neural Tube Defects
a. spina bifida
b. anencephaly
c. meningomyelocele
Medical Management for FDA
Folic Acid Supplement (oral/im)
Folic acid supplement (oral/im)
a. 400 microgram daily (expectant mother )
b. 600 microgram daily (pregnant
Nursing Management for FDA
a. Provide health teaching on importance of folic acid in fetal development
b. Eat foods rich in folic acid
c. Provide rest ever after activity
d. Practice hand washing
Eat foods rich in folic acid
a. Asparagus
b. Beef
c. Liver
d. Broccoli
e. Green leafy vegetables
f. Mushrooms
g. Oatmeal
h. Peanut butter
i. Wheat bread
j. Beans and legumes
k. Citrus fruits and juices
l. Dark green leafy vegetables
m. Pork
n. Poultry
o. Shellfish
p. Wheat bran
Sickle cell anemia
a. Group of inherited rbc disorder
b. Autosomal recessive
c. No known cure
d. Hemoglobin is not normal
e. Hard, sticky, sickle shape
f. RBC hemolysis early leading to anemia
g. Tend to stuck together when travelled to small blood vessels which causes blood clot, crisis, acute chest syndrome, stroke
h. Abnormal amino acid in hemoglobin creating an abnormal type of Hb called HbS
i. Characterized by the production of rigid, sickle-shaped red blood cells
j. Hemoglobin level 6-8 mg / 100 ml
Types of Sickle cell anemia
a. HbSS
b. HbSC
c. HbAS
HbSS
a. 2 abnormal S genes from mother and father
b. Most severe
HbSC
a. 1 hemoglobin S gene from 1 parent
b. Milder
HbAS
a. 1 hemoglobin gene from one parent A / hemoglobin A from a normal gene and 1 abnormal hemoglobin S gene
b. Sickle cell trait
c. Do not carry signs of the disease
d. Develops to health problems / severe form when person stresses the body ; dehydrated, infection, strenuous activity
e. The sickle cell trait can pass the abnormal trait to their children
Assessment for Sickle Cell Anemia
a. Increased bilirubin levels
b. Bacteriuria
c. HgB levels (6-8 mg/100ml)
d. Varicosities
e. Newborn Screening
f. Chorionic villi sampling
g. Amniocentesis
Increased bilirubin levels
a. By product after RBC hemolysis
b. Hyperbilirubinemia
Bacteriuria
Due to vascular stasis
Varicosities
a. lower extremities
b. Can lead to cell destruction
Chorionic villi sampling
Sample in placenta (chorionic villus)
Amniocentesis
Amniotic fluid sample
Effects of SCA to Mother
a. Risk to develop vasoocclusive crisis
b. Dehydration
c. Leg pain
d. Jaundice
Risk to develop vaso - occlusive crisis
Due to stress
Effects of SCA to Fetus
a. Abortion
b. Fetal death
c. Prematurity
d. Intrauterine growth restriction is also a characteristic findings in newborns of women with sickle cell anemia
Jaundice
Due to hyperbilirubinemia
4 types of Crisis
a. Vaso Occlusive crisis
b. Splenic sequestration crisis
c. Aplastic crisis
d. Acute Chest Syndrome
e. Hemolytic crisis
Vaso - occlusive crisis
a. Most common presentation of sickle cell crisis
b. Severe pain
c. Occurs when there is sickling of cells in blood vessels
Splenic sequestration crisis
a. Pain, tenderness and swelling in spleen of patient due to blood being trapped in spleen of patient
b. Commonly occurs to pediatric individuals
Aplastic crisis
a. Body doesn’t produce enough rbc to replace that is already in the blood
b. Trigger due to infection
c. Paleness, body weakness
Acute Chest Syndrome
a. One of the leading cause of hospitalization and mortality with patients have sickle cell anemia
b. Chest pain, coughing, fever, low blood oxygen level, abnormal substances being accumulated in lungs
Hemolytic crisis
a. Large amount of rbc are being destroyed over a short period of time
b. Sudden drop in Hgb levels
Medical & Surgical Management of SCA
a. Exchange transfusion
b. Intravenous fluid for rehydration (0.45 saline)
c. Administration of analgesics for pain
d. O2 therapy
e. Bone marrow transplantation
Exchange transfusion
a. Done throughout the pregnancy
b. To replace abnormal / sickled rbcs with normal rbcs
Intravenous fluid for rehydration (0.45 saline)
A hypotonic solution
Administration of analgesics for pain
Infection should be treated
Bone marrow transplantation
a. Only approved therapy by FDA that may be able to cure sickle cell disease
b. Will take healthy cells from donor and put bone marrow that is not working properly
c. Very risky surgical procedure
d. Not commonly done
e. Bone marrows should match ; brother and sister
Nursing Management for SCA
a. Teach the patient the early signs and symptoms of hypoxia & hypoxemia and sickle cell crisis
b. Encourage lifestyle behaviors
c. Encourage prevention of infections
Teach the patient the early signs and symptoms of hypoxia & hypoxemia and sickle cell crisis
Avoid triggers that may cause vasoconstriction such as physical or psychological stress whether cold weather, pain, alcohol, dehydration, infection
Encourage lifestyle behaviors
a. Drinking plenty of water
b. Trying not to go to a hot environment or to cold environment, avoid placed high in altitude, airplane, mountain climbing, cities high in altitude
c. Avoid that may cause hypoxemia and hypoxia
d. Prevent severe form of exercise
Encourage prevention of infections
a. Hand washing
b. Handle foot properly
c. Receiving of vaccines
