HCOP - Hematologic Complications of Pregnancy Joseph...

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Hematologic Complications of Pregnancy Joseph Breuner, MD October 10, 2006
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outline Anemia Thrombophilias Thrombocytopenia
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Case #1 Anemia, pro’s and cons of treating
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Anemia Which patients will benefit from iron treatment? What hematocrit at 28 wks should generate attention?
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Anemia Dilutional or physiologic Iron Deficiency Anemia Thalassemias
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Physiologic Anemia of Pregnancy
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Physiologic Anemia of Pregnancy Pregnancy-induced hypervolemia has several important functions: 1. To meet the demands of the enlarged uterus with its greatly hypertrophied vascular system. 2. To protect the mother, and in turn the fetus, against the deleterious effects of impaired venous return in the supine and erect positions. 3. To safeguard the mother against the adverse effects of blood loss associated with parturition. Williams 2006
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Physiologic Anemia of Pregnancy
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Physiologic Anemia of Pregnancy Normal hemoglobin by gest age in pregnant women taking iron supp 12 wks 12.2 [11.0-13.4] 24wks 11.6 [10.6-12.8] 40 wks 12.6 [11.2-13.6]
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Iron stores The amount of iron absorbed from diet, together with that mobilized from stores, is usually insufficient to meet the maternal demands imposed by pregnancy Williams 2006
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Iron stores Figure 5-6. Indices of iron turnover during pregnancy in women without overt anemia but who were not given iron supplementation. (From Kaneshige, 1981, with permission.)
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Prenatal vitamins At DFM contain 27 mg of elemental iron as ferrous fumarate Measured this way because different iron salts are absorbed differently
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Anemia-who to treat CDC: if Hgb is < 11 in 1 st or 3 rd tri, or <10.5 in 2 nd tri Obtain ferritin, cbc, smear, iron level If ferritin < 15 mcg/dl, confirms Fe def If ferritin <30 mcg/dl, 85% PPV and 90%NPV
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Anemia-who to treat ACOG-no specific recommendation Hemoglobinopathy bulletin recommends If MCV<80, obtain hgb electrophoresis Check ferritin. If ferritin >15, excludes iron-deficiency B- thal will have elevated Hgb A2 or F If both negative, send DNA thal screen for alpha- thal. Costs $35-50 at Dynacare, results take 3 wks
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Up to date: uses CDC definition 11/10.5 Follow with dx of cause of anemia: ferritin
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HCOP - Hematologic Complications of Pregnancy Joseph...

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