Obstetric haematology

Question 1

4 key changes in pregnancy

Answer 1

Mild anaemia (red cell mass increases 120-130% but plasma volume rises 150%)
Macrocytosis (independent of B12/folate)
Neutrophilia
Thrombocytopenia

Question 2

What happens to iron requirements in pregnancy?

Answer 2

Iron absorption normally very carefully controlled as we have limited excretion - only in squamous cells shed from gut lining
In pregnancy increased iron absorption for increased red cell mass + fetus
Increased daily absorption (1-2mg to 6mg) + RDA increase (10-20mg to 30mg)

Question 3

VWF multimers

Schistocytes

Answer 3

TTP

Question 4

Causes of thrombocytopenia in pregnancy

Answer 4

Physiological
Pre-eclampsia
ITP
MAHA (TTP, HUS, HELLP)

Question 5

What coagulation changes occur in pregnancy?

Answer 5

Hypercoaguable (factor VIII, VWF, fibrinogen, factor VII all increase)
Hypofibrinolytic (protein S, PAI-1 and PAI-2 decrease)

Increased coagulation + decreased fibrinolysis = Pro-coagulant state = Increased thrombosis risk