Haematology

Question 1

What is physiological anaemia of pregnancy

Answer 1

Plasma volume increases by more than haemoglobin mass

Question 2

Most common cause of true anaemia in pregnancy

Answer 2

Iron deficiency

Question 3

Complications of IDA

Answer 3

Maternal - fatigue, infection

Fetus - intrauterine growth restriction, premature, death

Question 4

Treatment for IDA

Answer 4

Oral ferrous sulphate

Iron infusion if poor compliance

Question 5

How is risk of NTDs reduced

Answer 5

400 micrograms folate OD 3 months pre-conceptually and first trimester

Question 6

Who needs a higher folic acid dose and what is the dose

Answer 6

5mg OD if:

Previous child with NTD
Increased cell turnover
Anticonvulsants

Question 7

Types of B12 deficiency in pregnancy

Answer 7

Physiological (dilutional in third trimester)

True

Question 8

Why is true B12 deficiency rare

Answer 8

Causes infertility

Question 9

Reasons for increased VTE risk in pregnancy

Answer 9

Decreased blood flow in legs due to gravis uterus
Increased clotting factors
Decreased protein S
Inhibition of fibrinolysis

Question 10

Difficulties of diagnosis for PE in pregnancy

Answer 10

D dimers raised in pregnancy
V/Q and CTPA high radiation risk to fetus

Use wells score and Perfusion scan

Question 11

Why are left VTE more common than right

Answer 11

Left iliac vein compressed by right iliac and ovarian arteries

Question 12

Treatment of VTE in pregnancy

Answer 12

LMWH

Question 13

Causes of maternal haemorrhage

Answer 13

Uterine atony e.g muscle fatigue in prolonged labour
Placenta Previa
Placenta abruption
Genital tract injury
Ectopic pregnancy 
Uterus rupture  
DIC
Dilutional coagulation deficit

Question 14

Describe haemolytic disease of the newborn

Answer 14

If mother is rhesus neg, fetus likely to be rhesus pos
Fetal cells released into maternal circulation in first pregnancy
Mother produces igM (can’t cross placenta) to rhesus D
On reexposure to rhesus D, mother produces IgG antibodies which cross placenta causing haemolysis in fetus

Question 15

Prevention of haemolytic disease of the newborn

Answer 15

RhesusD neg women have anti-D at week 28 and 34

Extra IM anti-D within 72 hours of a sensitising event

Question 16

Examples of sensitising events in terms of rhesus incompatibility

Answer 16

Delivery
Amniocentesis
Abdo trauma
Antepartum haemorrhage

Question 17

Monitoring for haemolytic disease of the newborn

Answer 17

Middle cerebral artery USS - high flow = higher risk of anaemia
Antibody levels

Question 18

Classification of alpha thalassaemia

Answer 18

1/2 genes missing: carrier
3 genes missing: HbH disease
4 genes missing: hydrops fetalis

Question 19

Clinical features of HbH disease

Answer 19

Microcytic anaemia
Splenomegaly
beta tetramers

Question 20

When does anaemia occur in beta thalassaemia major and why

Answer 20

3-6 months because of conversion of gamma to beta chains

Question 21

Clinical features of beta thalassaemia

Answer 21

Microcytic anaemia
Hepatosplenomegaly
Bone marrow hyperplasia - hair on end appearance of skull
Iron overload (transfusion)

Question 22

Diagnosis of beta thalassaemia carrier

Answer 22

Raised HbA2

Question 23

Describe ABO incompatibility

Answer 23

Mother O
Baby A/B/AB
Maternal antibodies cross placenta and cause allogenic haemolysis of the newborn

Question 24

Describe the kleihauer test

Answer 24

Detect fetal blood cells in maternal circulation after delivery to determine the amount of antiD to give the mother