Maternal Diseases: Hematologic Disorders

Question 1

What are some hemotaologic disorder examples? 3

Answer 1

1. Rh isoimmunization
2. Sickle cell anemia
3. Heterozygous thalassemia

Question 2

Rh isoimmunizartion is a hematologist disease of what?

Answer 2

Newborns

Question 3

What disease does Rh isoimmunization typically lead to?

Answer 3

Eryhtroblastosis fetalis

Question 4

How does RH isoimmunization happen? 2

Answer 4

1. Mom (Rh-) develops antibodies to surface antigens on fetal (Rh+) red blood cells
2. Mom’s antibodies attack and destroy fetal red blood cell

Question 5

What is erythroblastosis fetalis?

Answer 5

Rapid destruction of fetal red blood cells

Question 6

What happens as a result of erythroblastosis fetalis? 2

Answer 6

1. Outpouring of many new blood cells to compensate for the RBC destruction
2. The immature RBCs do not support or carry oxygen well

Question 7

When is RH isoimmunization usually prevalent?

Answer 7

Only in 2nd and subsequent pregnancies

Question 8

Why is RH isoimmunization on the decline?

Answer 8

Because of the introduction of preventative maternal immunologic blocking treatments

Question 9

What are some complications of RH isoimmunization? 5

Answer 9

1. Hepatosplenomegaly
2. Jaundice
3. Kernicterus
4. Congestive heart failure
5. Edema

Question 10

What is kernicterus?

Answer 10

Bilirubin in fetal blood destroys brain and spinal cord tissues

Question 11

What is the most severe form of RH isoimmunization? And what does it look like?

Answer 11

1. When RH isoimmunization becomes immune hydrops fetalis.
2. Fluid overload seen as pleural effusion and ascites in the fetus

Question 12

What is the maternal management of RH isoimmunization?

Answer 12

Rh- mothers will be given an injection of Rh immunoglobulin (WinRho or RhoGam) in first pregnancy at 28-32 weeks and again after delivery (within 72 hours)

Question 13

What does the RH immunoglobulin injections do for RH isoimmunization?

Answer 13

It will prevent the formation of antibodies in the mother

Question 14

What are some other indications for administering WinRho in the RH- patients? 4

Answer 14

1. Spontaneous abortion (72 hours)
2. Therapeutic abortion
3. Ectopic pregnancy after aminocentesis
4. Maternal hemorrhage, vaginal bleeding in pregnancy

Question 15

Should we give an injection to a RH+ mother?

Answer 15

Never

Question 16

What is the fetal assessment for Hemolytic disease?

Answer 16

BPP and Biometry in fetal assessment units

Question 17

When we assess for anemia, what does it look like sonographically? 2

Answer 17

1. Ascites appears first as echogenic bowel
2. Pleural effusion/ pericardial effusion

Question 18

When we do doppler of the MCA what do we see? 3 (What do we measure? >1.5 MoM means what? what do we need to do?)

Answer 18

1. Peak velocity of the MCA is measured
2. > 1.5 multiples of median (MoM) would indicate severe anemia in the fetus
3. Fetal blood transfusion would be required

Question 19

What are some things we do in sonography for hemolytic diseases? 3

Answer 19

1. Fetal assessment
2. Assessing for anemia
3. Doppler of the MCA is performed

Question 20

How does someone get sickle cell anemia?

Answer 20

It is an inherited disorder

Question 21

Which demographic of individuals is most affected by sickle cell anemia? 2

Answer 21

1. People of African descent
2. Can also affect those central/ South America, Caribbean islands, Mediterranean countries, India and Saudi Arabia

Question 22

What does sickle cell blood cells look like?

Answer 22

Sickle shaped

Question 23

What is the disadvantage of sickle cell anemia?

Answer 23

Poor fit in capillaries and small vessels resulting in anemia

Question 24

What are some possible complications of sickle cell anemia? 2

Answer 24

1. Maternal death
2. Spontaneous abortion

Question 25

How common is heterozygous thalassemia?

Answer 25

It is one of the most common autosomal recessive genetic abnormalities associated with pregnancy

Question 26

Where does heterozygous thalassemia occur? What does it do?

Answer 26

The mutation occurs on the same gene as sickle cell and reduces hemoglobin production

Question 27

What does heterozygous thalassemia result in? 2

Answer 27

1. Anemia 2. Can lead to non- immune hydrops and death