Pre conception care in thalassemia Flashcards
1
Q
Interventions which are beneficial at the preconceptual stage for thalassemia patients
A
- Aggressive chelation
2
Q
Which is the only safe agent for chelation in second and third trimester
A
- Desferrioxamine
- Deferasirox and deferiprone ideally discontinued 3 months before pregnancy
3
Q
Diabetes and thalassemia
A
Women with established diabetes mellitus should ideally have serum fructosamine concentrations
4
Q
Heart and thalassemia
A
- An echocardiogram and an electrocardiogram (ECG) should be performed as well as T2 cardiac MRI
- Aim for cardiac T2* > 20 ms wherever possible as this reflects minimal iron in the heart
- A T2*
5
Q
Liver and thalassemia
A
- Women should be assessed for liver iron concentration using a FerriScan® or liver T2*. the liver iron should be
6
Q
Bone density and thalassemia
A
- All women should be offered a bone density scan to document pre-existing osteoporosis.
- Serum vitamin D concentrations should be optimised with supplements if necessary
- All bisphosphonates are contraindicated in pregnancy
7
Q
Red cell antibodies and thalassemia
A
- ## Alloimmunity occurs in 16.5% of individuals with thalassaemia
8
Q
Which are the conditions at risk of serious fetal haemoglobinophaty
A
- Beta thalassaemia
- HbS
- HbE
- Delta beta thalassaemia
- Hb Lepore
- HbO Arab
- Hb Constant Spring
9
Q
Prophylaxis and immunizations and thalassemia
A
- Hepatitis B vaccination is recommended in HBsAg negative women who are transfused or may be
transfused. - Hepatitis C status should be determined.
- If undergone a splenectomy should take penicillin prophylaxis or equivalent.
- If undergone a splenectomy should be vaccinated for pneumococcus (every 5 years) and Haemophilus influenzae type b if this has not been done before.
- If undergone splenectomy are at risk of infection from encapsulated bacteria such as Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b
- If allergic to penicillin should be given erythromycin
