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Case 8 > Haematology And Pregnancy > Flashcards

Flashcards in Haematology And Pregnancy Deck (47)
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1
Q

What happens to cardiac output during pregnancy

A

Increases by 30-50% between 6-28 weeks gestation

2
Q

Describe what RBC, WBC and platelets look like on a bloodfilm

A

RBC - medium round but hollow circles

WBC -Vary but tend to be purple and bigger

Platelets - Small dark dots

3
Q

What is polycythaemia?

A

High Hb

4
Q

How does RBC mass rise in pregnancy in a normal woman and a woman on iron supplementation?

A

Normal: - 17% (240ml)

Iron - 29% (400ml)

5
Q

Why is there a relative decrease in RBC mass during pregnancy?

A

Big increase in plasma volume in first trimester

6
Q

What happens to RBC mass post-partum?

A

Falls at delivery due to bleeding

Returns to normal by 3 weeks.

7
Q

What happens to plasma volume throughout pregnancy?

A

Increases right from conception - by about 50% (2600ml)

Plateaus around last 8 weeks

8
Q

What does Hb normally stay above in pregnancy?

A

11.5 g/gL (115g/l)

9
Q

Why is their a physiological anaemia of pregnancy?

A

Although RBC mass increases, plasma volume increases more, resulting in a relative anaemia. Low Hb, haemocrit (Hct), RBC count but no effect on MCV.
Levels return to normal by labour

10
Q

When does Hb fall to its lowest in pregnancy?

A

32-34 weeks?

11
Q

What happens to MCV during pregnancy?

A

Doesn’t change (76-96 fL)

12
Q

What is Hemochromatosis?

A

Iron overload of any cause. Stores excess in major organs (not just liver)

13
Q

What is excess iron stored as?

A

Feerritin in liver

Haemosiderin in bone marrow

14
Q

What is the iron requirements of a pregnant female?

A

4-7mg/day

15
Q

What is norma serum ferritin levels?

A

> 15mcg/l

16
Q

What blood results indicate iron deficiency in pregnancy?

A

Hb <105g/l (consider if <115g/l)

MCV - goes up in pregnancy (fresh RBC are bigger) - can’t exclude iron deficiency in normal MCV. (can increase to 105fl)

Check serum ferritin (<15mcg/l) = anaemia

17
Q

What are the advantages and disadvantages to IV iron?

A

No advantages

Anaphylaxis in IV iron

18
Q

What are the side effects of oral iron?

A

Nausea, Abdo pain, Constipation, Diarrhoea, Black stools

19
Q

What does a deficiency in cobalamin and folate cause?

A

Impairs DNA production

Reduces RBC production

20
Q

If suspecting Folic acid or B12 deficiency, what might you measure?

A

Homocysteine - can’t recycle it if deficient (will increase)

21
Q

Do not measure B12 levels in pregnancy unless …

A

MCV high

Serum B12 falls in pregnancy. May be below 100pmol/l (normally >150)

22
Q

What is the normal requirement and pregnancy requirement of folic acid?

A

Normal - 100ug/day

Pregnancy - 300-400ug/day

23
Q

Why is folic acid deficiency uncommon?

A

Stores last for 3 months

24
Q

What is thrombocytosis?

A

High platelets (>500 x 10^9/l)

25
Q

What is thrombocytopenia?

A

Low platelets (<150x10^9/l)

26
Q

What can cause thrombocytopenia?

A

Reduced production of platelets (by bone marrow)

Increased consumption

27
Q

What is aplastic anaemia?

A

Bone marrow failure - reduced production

28
Q

What would happen to RBC, WBC and Platelets in blood marrow infiltration/failure/suppression?

A

Anaemia
Leucopenia
Thrombocytopenia

29
Q

What cell produces platelets in bone marrow?

A

Megakaryocytes

30
Q

Give some in and out of pregnancy causes of increased consumption of platelets

A

In or out:

  • Auto-immune
  • Sepsis
  • Massive haemorrhage
  • Cardiac bypass
  • Hyperslenism (more space for platelets)

Pregnancy:

  • HELLP
  • Pre-Eclampsia
  • Gestational thrombocytopenia
31
Q

What happens to RBC, WBC and platelets in increased consumption of platelets (thrombocytopenia)?

A
RBC = Normal
WBC= NORMAL
Platelets = REDUCED
32
Q

What is normal platelet count in pregnancy?

A

150-450 x 10^9 / l

Thrombocytopenia
<100 x 10^9 / l

33
Q

Why are pregnant women more likely to clot in pregnancy?

A

Virchow’s triad

increased pro-coagulant, Endothelial damage, venous stasis

34
Q

What vein is likely to compressed in pregnancy and why?

A

Left common iliac vein

Uterus growns - compresses on right iliac artery which in turn compresses the vein behind it

35
Q

What pregnancy risk factors increase the risk of Venous thromboembolism?

A
Hyperemesis
Pre-eclampsia 
Ovarian hyperstimulation syndrome 
Transfusion
Caesarian 
Instrumental delivery 
Obesity
36
Q

What is HELLP syndrome?

A

Rare liver and blood clotting disorder that can effect pregnant women

H - Haemolysis
EL - elevated liver enzymes
LP - Low platelet count

37
Q

Which is the universal RBC donor?

A

O group

38
Q

What is the platelet and plasma universal donor?

A

AB group

39
Q

Does blood group AB have A or B antigens?

A

NO - can receive any blood group

40
Q

If a pregnant woman is rhesus positive after her first born. What is the risk with the second born?

A

She will develop anti-D, it can cross the placenta and destroy the baby is also rhesus positive

41
Q

What do you do to prevent sensitisation of RhD-negative women during pregnancy?

A

Give them anti-D after each potentially sensitising even during the pregnancy.
Within 72h or childbirth (if child is RhD+)

42
Q

How are RBC stored?

A

4oC - half shelf life of 35 days

43
Q

How is FFP stored?

A

-30oC, shelf life of 24 months

44
Q

What is Cryoprecipitate?

A

Rich source of fibrinogen

45
Q

Should you give FFP to a warfarin patient?

A

NO, give Beriplex (prothrombin concentrate) to reverse its effects in life threatening situations

46
Q

Give 2 conditions when you would give FFP

A

DIC and TTP - clotting factors used up so need to be replaced

47
Q

How are platelets stored?

A

Room temperature, 5 day shelf life