Obstetric Haematology

Question 1

what does the FBC look like in pregnancy?

Answer 1

Low;
Neutrophils
Platelets
Anaemia (Macrocytosis)

Question 2

how do nutritional demand change in pregnancy

Answer 2

increased iron requirement (and absorption capacity)

increased folate requirement

Question 3

consequences of Iron deficiency in pregnancy?

Answer 3

IUGR, prematurity, postpartum haemorrhage

Question 4

what is Recommended daily intake of iron in pregnancy?

Answer 4

30 mg

Question 5

what is Recommended daily intake of collate in pregnancy?

Answer 5

400μg / day

Supplement before conception and for ≥ 12 weeks gestation

Question 6

In which stage is this defined as anaemia?

Hb < 100 g/l

Answer 6

postpartum

Question 7

In which stage is this defined as anaemia?

Hb < 105 g/l

Answer 7

2nd and 3rd trimester

Question 8

In which stage is this defined as anaemia?

Hb < 110 g/l

Answer 8

1st trimester

Question 9

which anaemia has the following film:

↓ Hb, ↓MCV , ↓ MCH, low MCHC,

Answer 9

iron deficiency

Question 10

which anaemia has the following film:

↓ Hb, ↓MCV , ↓ MCH, normal MCHC,
and low Ferritin

Answer 10

thalassaemia trait

treat If Ferritin <30

Question 11

what are 3 most common causes of Thrombocytopenia in pregnancy?

Answer 11

Physiological: ‘gestational’/incidental thrombocytopenia

Pre-eclampsia

Immune thrombocytopenia (ITP)

Question 12

when should thrombocytopenia become a worry in pregnancy

Answer 12

Platelets < 150 x 109/l

Question 13

a patient of a planet of less than 70. what is most implicated?

Answer 13

Immune thrombocytopenia (ITP)

Pre-eclampsia next

Question 14

what platelet count needed for delivery?

Answer 14

> 50x109/l sufficient for delivery

Question 15

what platelet count needed for epidural?

Answer 15

> 70

Question 16

when does mums Platelet count rise post partum?

Answer 16

Day2 – 5 post delivery

Question 17

how many preeclampsia patients get thrombocytopenia

Answer 17

50%

Question 18

name this phenomenon;

despite the platelet count being low, you have a paradoxically pro-thrombotic phenotype because the platelets are more aggregable

what conditions?

Answer 18

incipient DIC

when -> preeclampsia

patients get

-> thrombocytopenia

Question 19

Treatment options ITP (for bleeding or delivery)?

Answer 19

IV immunoglobulin
Steroids etc. – azathioprine*
(Anti-D where Rh D +ve)

Question 20

what’s happens in MAHA?

Answer 20

Deposition of platelets in small blood vessels = low platelets and destruction of RBCs

Question 21

blood film in MAHA looks like?

Answer 21

Film: Fragments - Schistocytes

polychromasia

Question 22

what is the leading cause of death in pregnancy?

Answer 22

Venous thromboembolism

Question 23

what are the coagulation changes in pregnancy?

Answer 23

HYPERCOAGULABLE - prevent heamorrhaging at delivery

HYPOFIBRINOLYTIC

Question 24

how does risk of thrombosis increase for >age35

Answer 24

doubles to;

2/1000

Question 25

what's virchows triad?

Answer 25

Changes in blood coagulation Reduced venous return ~85% Left DVT Vessel wall

Question 26

pregnant patient has chest pain / SOB / leg pain. potential problem? solution?

Answer 26

VTE thromboprophylaxis - advice: keep moving and stay hydrated!

Question 27

Women with risk factors of thrombosis should receive what for PREVENTION?

Answer 27

prophylactic heparin +TED stockings Either throughout pregnancy Or in peri-post- partum period Highest risk get adjusted dose LMWH heparin

Question 28

Women with actual thrombosis should receive what for TREATMENT? advice to medics?

Answer 28

LMWH heparin monitor anti Xa Stop for labour esp epidural

Question 29

why can't give warfarin to pregnant woman?

Answer 29

Warfarin is teratogenic weeks 6 -12 esp, embryopathy, fused epiphyses etc

Question 30

name a Thrombophilia associated with pregnancy complications?

Answer 30

Antiphospholipid Syndrome (APLS)

Question 31

Antiphospholipid Syndrome (APLS) has what outcome?

Answer 31

Recurrent miscarriage

Question 32

which antibodies point to Antiphospholipid Syndrome?

Answer 32

persistent Lupus anticoagulant (LA) and/or antiphospholipid antibodies

Question 33

lady has three or more consecutive miscarriages before 10 weeks of gestation. what condition?

Answer 33

Antiphospholipid Syndrome

Question 34

what medication improves live birth rate in APLS?

Answer 34

aspirin and heparin together

Question 35

Can you have Thrombophilias NOT associated with pregnancy complications?

Answer 35

YES examples; Protein C, Protein S deficiency, Factor V Leiden

Question 36

3rd most common cause of death in high income country pregnancy?

Answer 36

obstetric haemmorhage

Question 37

1 cause of haemorrhage in pregnancy?

Answer 37

Placental placement e.g. placenta praevia Placenta accreta

Question 38

Key reason for hysterectomy ?

Answer 38

obstetric haemmorhage

Question 39

what blood loss is normal in delivery>

Answer 39

Up to 500ml blood loss is considered normal!

Question 40

who is more likely to Require transfusion post partum?

Answer 40

c-sections

Question 41

why does the uterus bleed after delivery?

Answer 41

Uterine atony § Uterus does NOT contract sufficiently Trauma Haematological factors

Question 42

pregnancy lady presents in THIRD trimester with; sudden-onset shivers, vomiting, shock, DIC what condition? prognosis?

Answer 42

Amniotic Fluid Embolism ○ 86% mortality

Question 43

hydrops fetalis is seen in?

Answer 43

Alpha-0 thalassemia

Question 44

HPLC can identify haemoglobin variants except..? High-performance liquid chromatography

Answer 44

Alpha thalassemia

Question 45

On Red cell indices | MCH <27 indicates possible?

Answer 45

thalassaemia trait

Question 46

On Red cell indices MCH <25 indicates possible ... ?

Answer 46

possible α thal trait

Question 47

Hba2 is raised in .... ?

Answer 47

b thalassaemia trait.

Question 48

how to manage a mother with Sickle cell disease HbSS in pregnancy?

Answer 48

Red cell transfusion (top up or exchange) Prophylactic transfusion Alloimmunisation (make sure blood is matched)

Question 49

what is the RBC in 1. iron deficiency 2. thalassaemia trait

Answer 49

1. iron def : low/norm | 2. than : high

Question 50

Hb electrophoresis in iron deficiency is?

Answer 50

normal