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Flashcards in Haematological Conditions & Infectious Diseases Deck (58):

What is the composition of blood

55% Plasma
45% Red blood cells (erythrocytes)
0.1% White blood cells (leukocytes)
0.17% Platelets (thrombocytes)


What is plasma made up of

91% water
7% proteins
2% other solutes


What is the formed elements of blood made up of

White blood cells
Red blood cells


Explain: Plasma

liquid part of blood
- pale yellow
- is a colloid solution

- albumin
- globulins
- fibrinogen


Describe: Ethryrocytes

- no nucleaus
- made up of hemoglobin, lipids, ATP and carbonic anhydrase
- They transport oxygen from lungs to tissues and carbon dioxide from tissues to lungs


Describe: Hemaglobin

Consists of:
- 4 globin molecules: Transport carbon dioxide (carbonic anhydrase involved), nitric oxide
- 4 heme molecules: Transport oxygen
- Iron is required for oxygen transport


Define: Erythropoiesis

is the process by which new erythrocytes are made.

- It is stimulated by a decrease in oxygen in the blood
- detected by the kidneys
- kidney's then secrete hormone erythropoiesis.


List types of Leukocytes



Define: Hemostasis

is the process by which bleeding is stopped, which prevents excessive blood loss


What are the 3 steps on Hemostasis

Vascular spasm: smooth muscle of blood vessel contracts and pinches off blood supply to area injured

Platelet plug formation: Platelets detect and adhere to injured site, band together and release contents, ADP makes platelets sticky so other platelets stick to existing ones creating a platelet plug

Coagulation or blood clotting: aim is to contain blood into a gel.


What determines the a blood groups Rh

If a D antigen is present: Rh Positive (85% population)

Id D antigen is not present: Rh Negative (15% population)


Explain: Beta-Thalamassaemia

a group of hereditary disorders characterised by a genetic deficiency in the synthesis of beta-globin chain

Poor appetite
Developmental delay
Failure to thrive
Irritability, difficulty settling
Splenomegaly, growth failure with bone changes, fractures and leg ulcers also develop during childhood
Haemolytic anaemia
Carriers for β-thalassaemia are usually asymptomatic but may have mild hypochromic anaemia


Explain: Alpha-Thalassaemia

is caused my a mutation in the alpha gene of the hemaglobin molecule


If a woman tests positive for thalassaemia or has a known family history, what needs to happen

She needs genetic counselling
Partner needs to be tested


Explain: Sickle Cell Disease

is an autosomal receptive condition caused by a mutation in both copies of the β-(beta) globin genes

- carriers have 50% chance of passing the mutated gene onto their infant

- Most common inherited conditions of hemoglobin worldwide

• Anaemia
• Failure to thrive
• Repeated infections
• Painful swelling of the hands or feet
• Infarction
• Asplenia
• Abdominal pain
• Chest pain


Explain: Sickle cell trait

(term to describe the carrier state) is caused by a mutation in one copy of the β-globin
- carriers are usually healthy


Explain: Sickle cell pregnancy, labour/birth and postantal management

The risk in pregnancy depends on whether the woman has sickle cell disease or the sickle cell trait

- Sickle cell trait women- not at risk of significant pregnancy problems.
- Specialist management
- Iron deficient anaemia, need suppliment
- May experience frequent UTI.
- Hyperemesis may cause dehydration
- U/S (IUGR)

- IV fluids
- pain relief
- At risk: premature birth, placental abruption
- Mobilisation (immobility can cause sickle cell crises)
- PPH risk

- Monitor for PPH, dehydration, sickle cell crises
- Baby: screening for SC


What are 3 causes of Anaemia

- Inadequate production of erythrocytes: dietary, low bone marrow production, autoimmune reaction or disease
Rapid destruction of erythroctes: liver disease, lupus, sickle cell disease, malaria
Blood loss: gastrointestinal bleeding, haemophilia, haemorrhoids


Define: Coagulopathy

is any condition where there is impaired clotting ability
- inc. reduced ability or inability to clot and an extra ability to clot


What are the 2 main types of coagulopathy

Inherited: Autosomal dominant deficiencies
Aquired: occur in chronic disease state, after severe infection/viral infection, or with VitK deficiency


What is the diagnostic criteria for Thrombocytopaenia

Normal range: 150 000 to 450 000/ per microLitre

Diagnostic: <50 000
Signs and symptoms:
Bleeding gums


Define: Thrombocytopaenia

is an abnormally low amount of thrombocytes (platelets)


What are some cause of Thrombocytopaenia

Decreased platelet production: Leukaemia, anaemia, viral infections, HIV
Increased destruction: Autoimmune diseases, Blood borne bacterial infection
Medication induced: Quinine, alcohol abuse, interferon, chemotherapy, sulphur antibiotics


List common pre-existing infectious diseases

Herpes simplex
Hepatitis C
Hepatitis B
Sexually acquired
Varicella Zoster
Recurrent urinary tract infection
Helicobacter pylori
Group B streptococcus


What are 4 organisms responsible for infections in pregnancy

- Viral
- Bacterial
- Fungal
- Protozoan


What are 6 most common no-sexually transmitted infections

- Urinary tract infections - bacteriuria
- Bacterial vaginosis (BV)
- Candidiasis
- Group B streptococcus infection (GBS)
- Hepatitis B & C


What are 7 most common STIs

- Chlamydia
- Gonorrhea
- Herpes simplex virus type 2 (genital herpes)
- Human immunodeficiency virus (HIV)
- Human papillomavirus (HPV)
- Syphilis (Treponema pallidum)
- Trichomoniasis


Explain: UTI

Cause: often bacteria from the GI tract contaminating the perineal area

- common causative organisms: coliforms especially Escherichia coli, Klebsiella pneumoniae and Proteus species

Asympomatic bacturia: occurs in 2-10% of the pregnant population. During pregnancy, if the bacteriuria is left untreated 20-30%% of women will develop symptoms of UTI or pyelonephritis

Symptomatic bacteriuria: occurs in another 1-1.5%. Women with a UTI history and current bacteriuria are 10 times more likely to develop symptoms during pregnancy than women without either feature


What are the signs and symptoms of Acute cystitis infection and Kidney infection

Acute cystitis infection:
Frequency, dysuria, and urgency of urination or suprapubic or low back pain, haematuria

.Kidney infection: Pyelonephritis is usually present when fever, chills, nausea and vomiting, malaise and flank pain occur (CVAT)
- Incidence 1-2.5% with an increased risk of recurrence


Explain: Management of UTI

- Antibiotics as per organism sensitivity: 7-10 day course
- Increase fluids 1.5-2 litres/day
- void before and after intercourse to decrease the risk of recurrent UTI
- Hygiene: perineal hygiene, cotton underwear, avoidance of scented soaps, avoid tight fitting clothes
- Probiotoc intake while on antibiotic


What are 3 main types of Vaginal/Vulva infections

Bacterial vaginosis: anaerobic bacteria which change the normal vaginal flora to a small amount of lactobacilli which would normally produce lactic acid and maintain an acid pH

Trichomoniasis: vaginal infection caused by Trichomonas vaginalis, a flagellate protozoan that is most commonly sexually transmitted

Candidiasis: fungal infection causing vulvitis, vaginitis and vaginal discharge.


Explain: Bacterial Vaginosis in pregnancy

BV is present in up to 20% of women and the majority are asymptomatic

Main symptoms
- thin, grey/white vaginal discharge,
- may have increased vaginal discharge
- characterised by a fishy odour after intercourse
- Does not cause vaginal itching or dysuria

Effect on pregnancy
- increases the risk of spontaneous abortion
- TPL an LBW infants
- May cause neonatal septicaemia and postpartum endometritis


Explain: Management of Bacterial Vaginosis

Treatment: Antibiotics are highly effective. 7 day course of metronidazole (Flagyl) or oral clindamycin


Explain: Trichomoniasis in pregnancy

- Constant perineal itching
- vaginal discharge may be profuse
- frothy, yellow/green or grey and have a foul odour
- dyspareunia
- mild dysuria and lower abdominal pain

Effect on pregnancy
- Implicated in PROM, LBW and preterm birth


Explain: Management of Trichomoniasis

Treatment is for 5-7 days daily or in a large single dose of oral metrondiazole (Flagyl) and
- Treat the partner(s) too.


Explain: Candidiasis in pregnancy

Is a commensal and is found in the flora of the mouth, GIT and vagina

- Highest candidal colonisation rate in pregnancy is the third trimester with up to 50% of women affected

- Vaginal and vulva irritation
- pruritic
- white curd like vaginal discharge
- yeasty odour
- dysuria and dyspareunia


Explain: Management of Candidiasis (in pregnancy)

Treatment: Clotrimazole most commonly in a vaginal suppository or cream is used for 7 days at night to relieve the maternal symptoms and avoid occurrence of neonatal thrush. Also treat the partner


List 4 Bacterial infections and common perinatal complications

Group B streptococcus (GBS)

Most common perinatal complications associated with bacterial STIs are preterm labour, PROM and LBW babies


Explain: Chlamydia in pregnancy and management

Infection rates in pregnancy range from 2-30%.

Diagnosed: First pass U/A

asymptomatic (60%), vaginal discharge, abnormal bleeding, abdominal pain, fever, PID

Treatment: erythromycin, clindamycin or single dose azithromycin

Effect on pregnancy:
- Can cause amnionitis and postpartum endometritis
- 70% babies born to mothers with chlamydia become infected


Explain: Syphilis in pregnancy and management

Most women who have syphilis have no symptoms.

Diagnosis: Blood test. Syphilis can present as a primary genital ulcer, a rash of secondary syphilis or as a large number of serious conditions as part of tertiary syphilis, if left untreated

Treatment: single dose of 2.4 million units IMI benzyl penicillin

Effect on pregnancy:
- infect fetus
- spontaneous abortion
- preterm birth
- death
- Untreated primary or secondary syphilis in pregnant women causes almost a 100% infection rate in the fetus


Explain: GBS in pregnancy and management

is a naturally occurring Gram positive bacteria found in the rectovaginal flora of up to 25% of healthy women.

Treatment: Antibiotics in labour

Effects on pregnancy:
- Asymptomatic bacteriuria
- Intra-amniotic infection
- Endometritis
- Stillbirth
- Cultured in a urine sample and UTI
- Wound infections
- Preterm labour/birth
- Spontaneous miscarriage
- Sepsis across the perinatal period


List Viral infections

- Human papillomavirus (HPV) types 6 & 11
- Herpes simplex virus HSV-2 (genital herpes)
- Cytomegalovirus (CMV)
- Hepatitis B
- Hepatitis C
- Human Immunodeficiency Virus (HIV)


Explain: Human papillomavirus (HPV) and management

Responsible organisms are human wart viruses.

- most are asymptomatic
- can be transmitted before lesions appear
- Visible warty are fleshy coloured, pale pink or red, raised or flat and small or large

Effect on pregnancy
- In pregnancy warts tend to proliferate and become friable during pregnancy
- during delivery can cause pelvic outlet obstruction and severe haemorrhage related to lacerations of the friable condylomatous tissue.


Explain: Genital Herpes (HSV-2) and management

Is a double stranded DNA virus. Is a chronic infection characterised by periods of remissions and exacerbations

May be local or systemic
- Intense pain
- Dysuria
- Occasional itching vaginal discharge
- lymphadenopathy
- Viraemia: fever, headache, nausea, malaise and myalgia

Aciclovir (Zovirax) therapy continues to be the recommended treatment for HSV during pregnancy, as well as analgesia and topical anaesthetic gels
- Rest and good nutrition are recommedned to reduce possibility of outbreak

Effect on pregnancy:
- PROM increases chance of neonatal herpes
- Pre-existing herepes provides the fetus from infection due to maternal antibodies


Explain: Hep B and management

Transmitted by blood and body fluids.
- The organism is extremely hardy and can live outside the body in dried blood or body secretions for up to one week or more

- Pregnant women with acute hepatitis may be asymptomatic or
- chronic low grade fever,
- anorexia
- fatigue
- skin rashes


Explain: HepC and management

Hepatitis C is an RNA virus and is currently the most common bloodborne infection

- Majority of people are asymptomatic until significant liver damage results

Effect on pregnancy
- Avoid ARM and FSE in labour
- avoid B/F if cracked or bleeding nipples, or if the mother is symptomatic with a high viral load.


Explain: Rubella and management

Effect on pregnancy
- When maternal infection/exposure occurs in the first trimester, fetal infection rates are nearly 80% and the risk of miscarriage
- The risk of congenital defects after maternal infection is essentially limited to the first 16 weeks of gestation
- Maternal infection early in pregnancy can lead to fetal death, LBW, deafness, cataracts, jaundice, congenital heart disease, microcephaly and intellectual disability

Treatment: Rubella Vaccination POST delivery


Define: DIC

Disseminated Intravascular Coagulopathy


• primarily a thrombotic process

• a systemic process producing both thrombosis and haemorrhage

• also called consumption coagulopathy and defibrination syndrome.


Explain: DIC in obstetrics

is always a secondary complication of a condition that initiates coagulation-promoting factors into the maternal circulation. 

These conditions include amniotic fluid embolism, placental abruption, missed abortion, retained fetus syndrome, placenta praevia (occasionally), preeclampsia / eclampsia and HELLP syndrome.


List DIC risk factors/underlying causes

Trauma, burns, surgery and snake bite
- placental abruption 
- major haemorrhage 
- pre-eclampsia 
- retained dead fetus or placenta
- amniotic fluid embolism
- Placenta praevia
- Preeclampsia
- Eclampsia
- HELLP syndrome


List Warning Signs of DIC

- Profound haemorrhage
- Blood fails to clot
- Petechiae appear
- Bleeding from womans: eye, nose, gums, vagina, venipuncture site, surgical/episiotomy site
- Flank pain
- Abdominal distension
- Hypotension
- Cool skin
- Tachycardia


Explain: Management of DIC

- Identify and treat underlying cause
- If actively bleeding: platelet transfusion, fresh frozen plasma
- Use anticoagulants: to block thrombin and secondary fibrinolysis
- Insert indwelling urinary catheter, ideally with a measuring chamber, and monitor urinary output 
- Strict monitoring and recording of fluid balance


Explain: Toxoplasmosis

Is caused by a paralytic infection typically found in cats whose gut has digested the parasite and excretes it oocytes in their faeces

Acquired through
- Ingestion of undercooked meat
- Not washing hands thoroughly after gardening or cleaning cat litter
- Eating fruit and vegetables that aren't washed


Explain: Management of Toxoplasmosis in pregnancy, labour/birth, postnatal

First & Second Trimester Acquired Infection
- Miscarriage
- Congenital hydrocephalus
- Mental retardation
- Deafness or blindness
- Growth problems
Third Trimester Acquired Infection
- Retinochoroiditis develops later
- Stillbirth

- Mostly asymptomatic in healthy women
- Headache
- Sore throat
- Fever
- Fatigue

Antenatal issues:
- Educate on precautionary measures
- If woman has glandular like fever- consider toxoplasmosis and test bloods for: IgV and IgM (immunoglobulins)
- Pos: give Spiramycin

Labour/Birth issues:
- Normal practice
- If any fetal abnormalities consult paed and medical intervention required

Postnatal considerations:
- BF is ok- however check compatibility of drug if being treated for infection before BF
- Baby's born to infected mothers are monitored closely by the paediatrician


Explain: Cares and management required for a woman with ASD

Pregnancy issues:
- If treated, problems unlikely
- Specialised cardiac U/S for fetus needed
- Possible cardiac decompensation/ cardiac failure

Labour issues:
- Normal care if treated
- If untreated:
-- anaesthetic r/v prior to labour
-- compression stockings/ anticoagulation considered if immobile
-- 2nd Stage: restricted time frame for active pushing
- 3rd Stage: active management

Postnatal Issues:
- Baby needs cardio screening
- Standard contraception advice
- Encourage ambulation: decrease risk of thromboembolic disease
- follow up with cardiac specialist 6 weeks postpartum

- atrial fibrillation
- heart failure
- stroke


Explain: Cares and management required for a woman with Complex Hypertension

Pregnancy issues:
- increase surveillance (CTG and U/S)
- aspirin therapy
- U/A at each visit
- PE bloods: FBC, U&E, LFT
- Corticosteroids <34wks
- Psychosocial support
- Individual care plan
- ?admit as in-patient

Labour/Birth issues:
- EDB useful in conjunction w/ antihypertensive thereapy
- AVOID ergometrine, NSAIDs
- Oxytocin should be given slowly
- Hourly BP
- Continuous EFM

Postnatal issues:
- close observations of BP
- Repeat bloods
- Continue meds until BP stable
- Obstetric r/v at 6-8wks

- increase risk cardiovascular morbidity, hypertension, ischemic heart disease, stroke, VTE
- Annual BP check recommended


Explain: Cares and management required for a woman with Pyelonephritis

Possible indicators:
- UTI signs and symptoms
- dysuria
- haematuria
- bacteriuria (sympomatic)
- severe right flank pain
- costvertebral angle tenderness (CVAT)
- Acute pyelonephritis may present with pyrexia, rigors, abdominal/flank pain, nausea and vomiting

Pregnancy issues:
- U/A for diagnosis
- Obs
- Urgent r/v
- Bloods: cultures, FBC, LFT's, U&E's
- Abx
- Pain relief
- Cannulate and Fluids

Labour/Birth issues:
- Possible preterm labour
-- Steroids
-- Cont. EFM
-- Fluids
- UTI/Pyelonephritis in labour:
-- EFM
-- Abx
-- Regular voiding/monitor
- if possible avoid IDC

Postnatal issues:
- Paed r/v and U/S for reflux nephropathy
- GP follow up
- Renal follow up

Risks: Sepsis


Explain: Management of UTI in pregnancy, labour/birth and postnatal

- U/A screen
- Antibiotic therapy
- Risk of LBW and preterm birth if not treated

Labour and Birth
- Antibiotics
- EFM (for tachycardia is mother symptomatic)
- Regular voiding
- Monitor for maternal pyrexia and tachycardia

- neonate r/v for reflux nephropathy
- GP 6wks