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Leila's Yr 5 Pathology > Haematology 3 - Obstetric haematology > Flashcards

Haematology 3 - Obstetric haematology Flashcards

1
Q

Haematological changes in pregnancy (red cell mass, plasma volume, WCC, platelet count etc)

A

Red cell mass imncreases but plasma volume increases more –> dilutional anaemia
Thrombocytopenia
Neutrophilia
Macrocytosis (Can be normal or due to vitB12/Folate deficiency)

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2
Q

Effects of iron deficiency on foetus

A

IUGR, prematurity, PPH

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3
Q

WHO recommended supplementations in pregnancy

A

60mg daily iron, 400mcg folic acid from pre-conception until at least 12 weeks gestation
(5mg high dose)

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4
Q

What happens to platelet count and size in pregnancy?

A

Platelet count drops by~10% and platelets are bigger

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5
Q

Causes of thrombocytopenia in pregnancy?

A 
Gestational
ITP
Pre-eclampsia
HELLP
MAHA syndromes
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6
Q

Platelet count cutoffs important in pregnancy

A

You need >50x10^9/L for delivery

>70x10^9/L for spinal epidural

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7
Q

Why is pregnancy still a hypercoagulable state if there are fewer platelets?

A

Although there are fewer platelets, the platelets are more aggregable

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8
Q

When does platelet count remit?

A

2-5 days following delivery

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9
Q

Treatment options for ITP

A

IVIG, Steroids, anti-D (if RhD +Ve)

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10
Q

MOA of anti-d to treat ITP

A

The anti-D will coat the RBCs and get cleared by the reticuloendothelial system in preference of the antibodu covered platelets, thus conserving platelet levels

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11
Q

Is the foetus affected in ITP?

A

The baby may be affected because the IgG antibodies can cross the placenta

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12
Q

Treatment of TTP

A

Plasma exchange, delivery does not change the course of the disease

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13
Q

What is the leading cause of maternal death in the UK?

A

PE

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14
Q

What is the state in pregnancy described as?

A

Hypercoagulable hypofibrinolytic

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15
Q

Which factors are increaed in pregnancy?

A

Factor 8, vWF, fibrinogen, factor 7, factor 10

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16
Q

Which factors decrease in pregnancy?

A

Factor XI and protein S

17
Q

Which leg are most clots in pregnancy in?

A

Left leg

18
Q

When is the highest risk of VTE?

A

Post-partum period (6 weeks post term)

19
Q

What is the largest predictor of incidence in PE?

A

High BMI (>25)

20
Q

O ver which age does the risk of VTE increase?

A

Increases dramatically >35

21
Q

What is Virchow’s triad?

A

Vessel wall
Reduced venous return
Changes in blood coagulation

22
Q

Prevention of thromboembolic disease in pregnancy

A

TED stockings + heparin prophylaxis if risk factors

23
Q

Treatment of thromboembolic disease

A

LMWH and monitor with anti-Xa levels

24
Q

When would you stop LMWH prior to delivery?

A

24 hours after treatment dose, 12 hours after prophylactic dose

25
Q

Treatment in patients with APLS

A

heparin + aspirin

26
Q

Definition of PPH for SVD and C-section

A

SVD: >500mL

C-section: >1000ml Blood

27
Q

Which infeciton in pregnancy –> hydrops fetalis

A

Parvovirus infection

28
Q

What tests are offered to diagnose haemaglobinopathies in the foetus in utero?

A

CVS 11-14th week
amniocentesis 15-20 weeks
cffDNA

29
Q

What would a low MCH in parents possibly suggest

A

a possible thalassaemia trait

30
Q

Is the baby’s platelet count affected in gestational thrombocytopenia?

A

No

31
Q

What investigation can be used to identify Hb variants e.g. HbS, HbC

A

HPLC (cannot detect alpha thalassaemia)

32
Q

Maternal complications if have SCD

A

Vaso-0cclusive crises become more frequent in pregnancy

33
Q

Complications of SCD in pregnancy

A

Fetal growth restriction, miscarriage, preterm labour, pre-eclampsia, venous thrombosis

34
Q

Treamtnet if SCD in pregnancy

A

Red cell transfusion, alloimmunisation, prophylactic transfusion

35
Q

How are patients chosen to be screened for SCD?

A

Depends on family origins questionnaire

36
Q

Which immunoglobulin class mediated HDN?

A

IgG

37
Q

Complications of HDN

A

Hydrops, foetal anaemia, neonatal jaundice, kernicterus

38
Q

How can you monitor anaemia in foetus?

A

MCA doppler USS

Leila's Yr 5 Pathology (100 decks)

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