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Path - Haem > Obstetric Haematology > Flashcards

Obstetric Haematology Flashcards

1
Q

what does the FBC look like in pregnancy?

A

Low;
Neutrophils
Platelets
Anaemia (Macrocytosis)

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2
Q

how do nutritional demand change in pregnancy

A

increased iron requirement (and absorption capacity)

increased folate requirement

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3
Q

consequences of Iron deficiency in pregnancy?

A

IUGR, prematurity, postpartum haemorrhage

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4
Q

what is Recommended daily intake of iron in pregnancy?

A

30 mg

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5
Q

what is Recommended daily intake of collate in pregnancy?

A

400μg / day

Supplement before conception and for ≥ 12 weeks gestation

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6
Q

In which stage is this defined as anaemia?

Hb < 100 g/l

A

postpartum

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7
Q

In which stage is this defined as anaemia?

Hb < 105 g/l

A

2nd and 3rd trimester

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8
Q

In which stage is this defined as anaemia?

Hb < 110 g/l

A

1st trimester

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9
Q

which anaemia has the following film:

↓ Hb, ↓MCV , ↓ MCH, low MCHC,

A

iron deficiency

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10
Q

which anaemia has the following film:

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

A

thalassaemia trait

treat If Ferritin <30

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11
Q

what are 3 most common causes of Thrombocytopenia in pregnancy?

A

Physiological: ‘gestational’/incidental thrombocytopenia

Pre-eclampsia

Immune thrombocytopenia (ITP)

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12
Q

when should thrombocytopenia become a worry in pregnancy

A

Platelets < 150 x 109/l

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13
Q

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

A

Immune thrombocytopenia (ITP)

Pre-eclampsia next

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14
Q

what platelet count needed for delivery?

A

> 50x109/l sufficient for delivery

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15
Q

what platelet count needed for epidural?

A

> 70

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16
Q

when does mums Platelet count rise post partum?

A

Day2 – 5 post delivery

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17
Q

how many preeclampsia patients get thrombocytopenia

A

50%

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18
Q

name this phenomenon;

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

what conditions?

A

incipient DIC

when -> preeclampsia

patients get

-> thrombocytopenia

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19
Q

Treatment options ITP (for bleeding or delivery)?

A

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

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20
Q

what’s happens in MAHA?

A

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

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21
Q

blood film in MAHA looks like?

A

Film: Fragments - Schistocytes

polychromasia

22
Q

what is the leading cause of death in pregnancy?

A

Venous thromboembolism

23
Q

what are the coagulation changes in pregnancy?

A

HYPERCOAGULABLE - prevent heamorrhaging at delivery

HYPOFIBRINOLYTIC

24
Q

how does risk of thrombosis increase for >age35

A

doubles to;

2/1000

25
Q

what’s virchows triad?

A

Changes in blood coagulation

Reduced venous return
~85% Left DVT

Vessel wall

26
Q

pregnant patient has chest pain / SOB / leg pain.

potential problem?
solution?

A

VTE

thromboprophylaxis - advice: keep moving and stay hydrated!

27
Q

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

A

prophylactic heparin +TED stockings

Either throughout pregnancy Or in peri-post- partum period

Highest risk get adjusted dose LMWH heparin

28
Q

Women with actual thrombosis should receive what for TREATMENT?

advice to medics?

A

LMWH heparin

monitor anti Xa

Stop for labour esp epidural

29
Q

why can’t give warfarin to pregnant woman?

A

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

30
Q

name a Thrombophilia associated with pregnancy complications?

A

Antiphospholipid Syndrome (APLS)

31
Q

Antiphospholipid Syndrome (APLS) has what outcome?

A

Recurrent miscarriage

32
Q

which antibodies point to Antiphospholipid Syndrome?

A

persistent Lupus anticoagulant (LA)

and/or

antiphospholipid antibodies

33
Q

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

what condition?

A

Antiphospholipid Syndrome

34
Q

what medication improves live birth rate in APLS?

A

aspirin and heparin together

35
Q

Can you have Thrombophilias NOT associated with pregnancy complications?

A

YES

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

36
Q

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

A

obstetric haemmorhage

37
Q

1 cause of haemorrhage in pregnancy?

A

Placental placement

e.g.
placenta praevia
Placenta accreta

38
Q

Key reason for hysterectomy ?

A

obstetric haemmorhage

39
Q

what blood loss is normal in delivery>

A

Up to 500ml blood loss is considered normal!

40
Q

who is more likely to Require transfusion post partum?

A

c-sections

41
Q

why does the uterus bleed after delivery?

A

Uterine atony
§ Uterus does NOT contract sufficiently
Trauma
Haematological factors

42
Q

pregnancy lady presents in THIRD trimester with;

sudden-onset shivers, vomiting, shock, DIC

what condition? prognosis?

A

Amniotic Fluid Embolism

	○ 86% mortality
43
Q

hydrops fetalis is seen in?

A

Alpha-0 thalassemia

44
Q

HPLC can identify haemoglobin variants except..?

High-performance liquid chromatography

A

Alpha thalassemia

45
Q

On Red cell indices

MCH <27 indicates possible?

A

thalassaemia trait

46
Q

On Red cell indices

MCH <25 indicates possible … ?

A

possible α thal trait

47
Q

Hba2 is raised in …. ?

A

b thalassaemia trait.

48
Q

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

A

Red cell transfusion (top up or exchange)

Prophylactic transfusion

Alloimmunisation (make sure blood is matched)

49
Q

what is the RBC in

  1. iron deficiency
  2. thalassaemia trait
A
  1. iron def : low/norm

2. than : high

50
Q

Hb electrophoresis in iron deficiency is?

A

normal

Path - Haem (13 decks)

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