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Year 5 Pathology Revision > Haematology 11: Obstetric Haematology > Flashcards

Haematology 11: Obstetric Haematology Flashcards

(46 cards)

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1
Q

Why are pregnant women anaemic despite an average Red cell mass increase of 120-130% ?

A

Plasma volume increases by 150% causing a net dilution

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2
Q

What is the WHO recommended daily Iron and folate supplementation for pregnant women ?

A

60mg iron

400mcg folate

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3
Q

What are pregnant women with thrombocytopenia at risk of when receiving epidural anaesthesia?

A

Spinal haematoma

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4
Q

What happens to platelets in pregnancy ?

A

They become larger

They are sometimes counted as RBCs by the FBC machine

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5
Q

List 4 causes of thrombocytopenia in pregnancy ?

A

Gestational thrombocytopenia (physiological)
Placenta praevia
ITP
MAHA

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6
Q

List 4 causes of MAHA ?

A

TTP- thrombotic Thrombocytopaenia purpura
HUS- Haemolytic uraemic syndrome
HELLP - haemolysis elevated liver enzymes and low platelets
Pre eclampsia

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7
Q

Why does pregnancy induce a net procoagulant state ?

A

To rapidly control bleeding at the placental site after delivery

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8
Q

Which anticoagulant factor falls to half the normal level during pregnancy ?

A

Protein S

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9
Q

Which coagulation factors increase the most during pregnancy ?

A

Factor VIII and vWF (3-5 fold)

Other factors that increase: Fibrinogen (2 fold) and factor VII (0.5 fold)

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10
Q

Which antifibrolytic factors increase during pregnancy ?

A

PAI-1 and 2

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11
Q

Which antifibrinolytic factor is produced by the placenta during pregnancy ?

A

PAI-2

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12
Q

During pregnancy the body assumes a ……….coagulant and ………… fibrinolytic state

A

Hypercoagulant

Hypofibrinolytic

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13
Q

Is D-dimer useful for exclusion of DVT in pregnancy ?

A

No

D-dimer is physiologically elevated in pregnancy

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14
Q

Which autoantibody is present in APLS ?

A

Anti-cardiolipin antibodies

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15
Q

Which 2 medications are recommended in APLS ?

A

LMWH + aspirin

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16
Q

Give 3 indications for testing for APLS ?

A
  • 3 or more consecutive miscarriages <10 weeks gestation
  • 1 morphological normal foetal loss > 10 weeks gestation
  • 1 or more preterm births before 34 weeks gestation thought to be due to placental disease
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17
Q

What is placenta accreta ?

A

When the placenta goes through the endometrial lining (becomes difficult to deliver)

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18
Q

What is placenta increta ?

A

The placenta goes through the uterine wall

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19
Q

What is placenta percreta ?

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A

Placenta goes through the uterine wall and attaches to other organs

20
Q

What is a risk factor for placenta accreta ?

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A

Previous C section

21
Q

What is a complication of placenta accreta ?

22
Q

Define post partum haemorrhage (PPH) ?

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A

> 500ml blood loss in the first 24 hours of pregnancy

23
Q

What are the 4Ts of causes of PPH ?

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A

Tone - uterine atony
Tissue- placenta accreta
Trauma- instrumental delivery
Thrombin- DIC

24
Q

How does amniotic fluid embolism present ?

Study These Flashcards
A

Sudden onset shivers, vomiting, shock and DIC

25
Which modality is used to diagnose haemoglobin variants ?
HPLC (high power liquid chromatography)
26
Elevated HbA2 >3.5% suggests which thalassaemia ?
Beta thalassaemia
27
How are pregnant women with sickle cell disease managed ?
Top up or exchange red cell transfusions prophylactic transfusions Alloimmunisation (make sure the blood is matched)
28
3 blood changes in pregnancy
mild anaemia - RBC mass rises, plasma volume rises, net dilution macrocytosis neutrophilia thrombocytopaenia
29
when should a pregnant lady take folate
from before conception to > 12 weeks gestation
30
what platelet counts are sufficient for delivery/pidural
delivery > 50x109/L | epidural >70x109/L
31
treatment for ITP
IVIG steroids anti-D where RhD +ve
32
what happens in MAHA in pregnancy
deposition of platelet-rich thrombin in small BV - shearing of RBC - haemolytic anaemia thrombocytopenia organ damage (kidney, CNS, placenta)
33
treatment for TTP
delivery does not affect the course of TTP or HUS | plasma exchange
34
when do most PE deaths occur in pregnancy
40-46 weeks
35
what investigations are safe in pregnancy for thrombosis
dopplet and VQ scans
36
what factors increase the risk of thrombosis in pregnancy
all - changes in blood coagulation, reduced venous return, vessel wall variable - hypremesis/dehydration, bed rest, obesity, pre-eclampsia. operative delivery, previous thrombosis/thrombophilia, age over 35, parity, other medical problems, IVF (ovarian hyperstimulation)
37
prevention of thromboembolic disease in pregnancy
prophylactic heparin + TEDs mobilise hydration high risk - LMWH
38
treatment for thromboembolic disease in pregnancy
LMWH do not use warfarin as teratogenic stop anticoagulation before delivery
39
when can an epidural be given post heparin
24 hrs after treatment dose | 12 hrs after prophylactic dose
40
effects of thrombophilia on the pregnancy
``` associated with impaired placental circulation IUGR recurrent miscarriage late foetal loss abrupto placenta severe pre-eclampsia toxaemia ```
41
define placenta accreta, increta, percreta
accreta - goes trhough endometrial lining increta - through uterine wall percreta - through uterine wall and sticks to other organs
42
three things we screen for in terms of haemoglobinopathies
alpha-0-thalassaemia - death in utero beta- 0 -thalassaemia - transfusion dependent HbSS - 43 yr LE
43
counselling about haemoglobinopathies
``` all important ones are recessive test partner oprions: proceed prenatal diagnosis - CVS sampling, amniocentesis, Us for hydrops ```
44
complications of SCD in pregnancy
``` foetal GR miscarriage preterm labour pre-eclampsia venous thrombosis ```
45
management of SCD in pregnancy
RBC transfusion prophylactic transfusion alloimmunisation
46
iron deficiency vs thalassaemia trait
``` iron def: Hb normal/low MCH low MCHC low RDW high RC low/normal Hb electrophoresis normal ``` ``` thalassameia trait: Hb normal MCH low MCHC preserved RDW normal RBC high Hb electrophoresis Hb A1c high in B that, normal in a thal trait ```

Year 5 Pathology Revision (106 decks)

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