Podcast
Questions and Answers
What is the most prevalent risk factor for red blood cell isoimmunization?
What is the most prevalent risk factor for red blood cell isoimmunization?
- Organ or tissue transplantation
- Pregnancy (correct)
- Traumatic injuries
- Blood transfusion
Which of the following conditions is NOT an inherited anemia of pregnancy?
Which of the following conditions is NOT an inherited anemia of pregnancy?
- Thrombophilia (correct)
- Spherocytosis
- Elliptocytosis
- G6PD deficiency
What is the primary concern regarding red blood cell isoimmunization in pregnancy?
What is the primary concern regarding red blood cell isoimmunization in pregnancy?
- Risk of blood clots
- Increased risk of miscarriage
- Fetal anemia (correct)
- Maternal anemia
What does the term "isoimmunization" refer to?
What does the term "isoimmunization" refer to?
What is the primary reason for the prevalence of Rh factor isoimmunization?
What is the primary reason for the prevalence of Rh factor isoimmunization?
What is the name of the prophylactic treatment used to prevent RHD antibody production?
What is the name of the prophylactic treatment used to prevent RHD antibody production?
What is the function of RhoD immunoglobulin?
What is the function of RhoD immunoglobulin?
Which of the following conditions is NOT a hemoglobinopathy?
Which of the following conditions is NOT a hemoglobinopathy?
What is the standard dose of RhoD immunoglobulin administered via intramuscular injection?
What is the standard dose of RhoD immunoglobulin administered via intramuscular injection?
When is RhoD immunoglobulin typically administered during pregnancy?
When is RhoD immunoglobulin typically administered during pregnancy?
What is the purpose of the Kleinhauer-Betke (KB) test?
What is the purpose of the Kleinhauer-Betke (KB) test?
When is a second dose of RhoD immunoglobulin typically given?
When is a second dose of RhoD immunoglobulin typically given?
What is the maximum volume of fetal blood that a standard 300 microgram dose of RhoD immunoglobulin can protect against?
What is the maximum volume of fetal blood that a standard 300 microgram dose of RhoD immunoglobulin can protect against?
What is a potential complication of a large maternal-fetal transfusion?
What is a potential complication of a large maternal-fetal transfusion?
What is the recommended timeframe for administering RhoD immunoglobulin after a potential exposure event?
What is the recommended timeframe for administering RhoD immunoglobulin after a potential exposure event?
What is the purpose of performing an antibody screen on pregnant women at the initiation of prenatal care?
What is the purpose of performing an antibody screen on pregnant women at the initiation of prenatal care?
Which of the following red blood cell antigens is most commonly associated with severe fetal hemolytic anemia?
Which of the following red blood cell antigens is most commonly associated with severe fetal hemolytic anemia?
What is a potential reason for repeating an antibody screen at the time of RhoD prophylaxis between 26 and 28 weeks of gestation?
What is a potential reason for repeating an antibody screen at the time of RhoD prophylaxis between 26 and 28 weeks of gestation?
What is the most common clinical presentation of fetal effects of isoimmunization?
What is the most common clinical presentation of fetal effects of isoimmunization?
What is hydrops fetalis?
What is hydrops fetalis?
What is the most common cause of fetal anemia leading to hydrops fetalis?
What is the most common cause of fetal anemia leading to hydrops fetalis?
When is a mini-dose formulation of RhoD immunoglobulin typically used?
When is a mini-dose formulation of RhoD immunoglobulin typically used?
What is the inheritance pattern of Rh status?
What is the inheritance pattern of Rh status?
Which of the following situations would NOT typically require RhoD immunoglobulin prophylaxis?
Which of the following situations would NOT typically require RhoD immunoglobulin prophylaxis?
What is the defining characteristic of heritable anemias as opposed to other types of anemia?
What is the defining characteristic of heritable anemias as opposed to other types of anemia?
What is the most common form of anemia during pregnancy?
What is the most common form of anemia during pregnancy?
What is the significance of the CDC's changing definition of anemia during pregnancy based on trimesters?
What is the significance of the CDC's changing definition of anemia during pregnancy based on trimesters?
Why are hemoglobin and hematocrit values considered late indicators of iron deficiency anemia?
Why are hemoglobin and hematocrit values considered late indicators of iron deficiency anemia?
Which of the following statements accurately describes the inheritance pattern of G6PD deficiency?
Which of the following statements accurately describes the inheritance pattern of G6PD deficiency?
What is the most common factor that triggers a hemolytic crisis in individuals with spherocytosis?
What is the most common factor that triggers a hemolytic crisis in individuals with spherocytosis?
How do heritable anemias differ from other types of anemia in terms of their impact on pregnancy?
How do heritable anemias differ from other types of anemia in terms of their impact on pregnancy?
What is the potential impact of high hemoglobin and hematocrit levels during pregnancy?
What is the potential impact of high hemoglobin and hematocrit levels during pregnancy?
What is the primary difference between G6PD deficiency and spherocytosis?
What is the primary difference between G6PD deficiency and spherocytosis?
Which of the following statements is TRUE regarding elliptocytosis?
Which of the following statements is TRUE regarding elliptocytosis?
Why are blood volume expansions during pregnancy crucial for fetal health?
Why are blood volume expansions during pregnancy crucial for fetal health?
What is the primary concern regarding hemoglobinopathies in pregnancy?
What is the primary concern regarding hemoglobinopathies in pregnancy?
How can heritable anemias complicate pregnancy?
How can heritable anemias complicate pregnancy?
What is the primary reason for the high rate of maternal deaths attributed to anemia in third world countries?
What is the primary reason for the high rate of maternal deaths attributed to anemia in third world countries?
Which of the following hemoglobinopathies is characterized by a quantitative abnormality in hemoglobin synthesis?
Which of the following hemoglobinopathies is characterized by a quantitative abnormality in hemoglobin synthesis?
What are the implications of reduced oxygen availability in the fetal environment?
What are the implications of reduced oxygen availability in the fetal environment?
Which of the following statements is TRUE about the inheritance pattern of spherocytosis?
Which of the following statements is TRUE about the inheritance pattern of spherocytosis?
What is the primary effect of the genetic defect in spherocytosis?
What is the primary effect of the genetic defect in spherocytosis?
What is the physiological mechanism behind the link between anemia and preterm labor?
What is the physiological mechanism behind the link between anemia and preterm labor?
What is the primary focus of this content?
What is the primary focus of this content?
Which of the following conditions is commonly characterized by a hyperproliferative anemia?
Which of the following conditions is commonly characterized by a hyperproliferative anemia?
What is the primary recommendation for prenatal care for women with spherocytosis?
What is the primary recommendation for prenatal care for women with spherocytosis?
What is the most accurate interpretation of the statement: "Hemoglobin and hematocrit values are late indicators of oxygen-carrying capacity changes for red blood cells when iron deficiency is suspected"?
What is the most accurate interpretation of the statement: "Hemoglobin and hematocrit values are late indicators of oxygen-carrying capacity changes for red blood cells when iron deficiency is suspected"?
What is the primary difference between elliptocytosis and spherocytosis?
What is the primary difference between elliptocytosis and spherocytosis?
Why do hemoglobin and hematocrit values tend to be lower among African-Americans?
Why do hemoglobin and hematocrit values tend to be lower among African-Americans?
Which of the following is a diagnostic test for elliptocytosis?
Which of the following is a diagnostic test for elliptocytosis?
Which specific hemoglobin is the most abundant form during the fetal period?
Which specific hemoglobin is the most abundant form during the fetal period?
Which of the following is NOT mentioned as a potential factor affecting hemoglobin and hematocrit values?
Which of the following is NOT mentioned as a potential factor affecting hemoglobin and hematocrit values?
What is the most prevalent form of hemoglobin in adults?
What is the most prevalent form of hemoglobin in adults?
What is the most significant consequence of anemia during pregnancy, as highlighted in the content?
What is the most significant consequence of anemia during pregnancy, as highlighted in the content?
Which of the following accurately describes the effect of the genetic defect in elliptocytosis?
Which of the following accurately describes the effect of the genetic defect in elliptocytosis?
What is the main difference between alpha and beta thalassemia?
What is the main difference between alpha and beta thalassemia?
What is the primary difference between thalassemia and structural hemoglobinopathies?
What is the primary difference between thalassemia and structural hemoglobinopathies?
What is the inheritance pattern of thalassemias?
What is the inheritance pattern of thalassemias?
What is the most severe form of alpha thalassemia that is compatible with life outside the womb?
What is the most severe form of alpha thalassemia that is compatible with life outside the womb?
What is the primary function of the alpha and beta chains in hemoglobin?
What is the primary function of the alpha and beta chains in hemoglobin?
What is the most common cause of alpha thalassemia?
What is the most common cause of alpha thalassemia?
What clinical feature is commonly observed in individuals with both alpha and beta thalassemia?
What clinical feature is commonly observed in individuals with both alpha and beta thalassemia?
What is the characteristic clinical feature of alpha thalassemia trait?
What is the characteristic clinical feature of alpha thalassemia trait?
What is the underlying cause of beta thalassemia?
What is the underlying cause of beta thalassemia?
What is the clinical approach to diagnosing beta thalassemia?
What is the clinical approach to diagnosing beta thalassemia?
What is the most common outcome of a homozygous alpha thalassemia (all four alpha globin genes inactive)?
What is the most common outcome of a homozygous alpha thalassemia (all four alpha globin genes inactive)?
Which of the following is NOT a common symptom or clinical finding in individuals with alpha thalassemia?
Which of the following is NOT a common symptom or clinical finding in individuals with alpha thalassemia?
What is the primary reason why beta thalassemia often leads to severe anemia?
What is the primary reason why beta thalassemia often leads to severe anemia?
Why are thalassemias more common in certain populations like Mediterranean, African, Middle Eastern, and Southeast Asian populations?
Why are thalassemias more common in certain populations like Mediterranean, African, Middle Eastern, and Southeast Asian populations?
What is the main function of hemoglobin F, or fetal hemoglobin, in the fetus?
What is the main function of hemoglobin F, or fetal hemoglobin, in the fetus?
What is the primary reason for recommending a daily supplement of folic acid for women with sickle cell disease?
What is the primary reason for recommending a daily supplement of folic acid for women with sickle cell disease?
Which of the following statements accurately describes the characteristics of women with sickle cell trait?
Which of the following statements accurately describes the characteristics of women with sickle cell trait?
What is the primary concern regarding the inheritance of sickle cell disease in women with sickle cell trait?
What is the primary concern regarding the inheritance of sickle cell disease in women with sickle cell trait?
What is the defining characteristic of hemoglobin S that leads to sickle cell disease?
What is the defining characteristic of hemoglobin S that leads to sickle cell disease?
Which of the following is NOT a hallmark of care for a pregnant woman experiencing a sickle cell crisis?
Which of the following is NOT a hallmark of care for a pregnant woman experiencing a sickle cell crisis?
What is the clinical significance of identifying hemoglobin C or hemoglobin E in a pregnant woman?
What is the clinical significance of identifying hemoglobin C or hemoglobin E in a pregnant woman?
Which of the following is a common characteristic of both thrombocytopenia and antiphospholipid syndrome in pregnancy?
Which of the following is a common characteristic of both thrombocytopenia and antiphospholipid syndrome in pregnancy?
What is the clinical threshold for diagnosing thrombocytopenia in pregnant women?
What is the clinical threshold for diagnosing thrombocytopenia in pregnant women?
How does antiphospholipid syndrome affect pregnancy outcomes?
How does antiphospholipid syndrome affect pregnancy outcomes?
What is the primary concern for women with thrombocytopenia during labor and delivery?
What is the primary concern for women with thrombocytopenia during labor and delivery?
What type of management strategy is typically used for women with antiphospholipid syndrome during pregnancy?
What type of management strategy is typically used for women with antiphospholipid syndrome during pregnancy?
What is the estimated contribution of thrombophilias to thromboembolic events in pregnancy?
What is the estimated contribution of thrombophilias to thromboembolic events in pregnancy?
What is the primary characteristic of thrombophilias that makes them a concern for pregnancy?
What is the primary characteristic of thrombophilias that makes them a concern for pregnancy?
Which of the following conditions generally indicates the need for anticoagulation therapy during pregnancy?
Which of the following conditions generally indicates the need for anticoagulation therapy during pregnancy?
What is the most likely complication of antiphospholipid syndrome during pregnancy?
What is the most likely complication of antiphospholipid syndrome during pregnancy?
What symptoms are commonly associated with deep vein thrombosis (DVT)?
What symptoms are commonly associated with deep vein thrombosis (DVT)?
What is the role of midwives in the care of pregnant women with sickle cell trait or disease?
What is the role of midwives in the care of pregnant women with sickle cell trait or disease?
When is fetal surveillance generally recommended for women with thrombophilias?
When is fetal surveillance generally recommended for women with thrombophilias?
Which of the following is NOT a typical feature of antiphospholipid syndrome?
Which of the following is NOT a typical feature of antiphospholipid syndrome?
Which of the following statements regarding pulmonary embolism (PE) during pregnancy is true?
Which of the following statements regarding pulmonary embolism (PE) during pregnancy is true?
What role do midwives often play in the management of thromboembolism during pregnancy?
What role do midwives often play in the management of thromboembolism during pregnancy?
What is a significant indicator for prophylactic anticoagulation during pregnancy?
What is a significant indicator for prophylactic anticoagulation during pregnancy?
What type of thrombophilia is most influential on pregnancy outcomes?
What type of thrombophilia is most influential on pregnancy outcomes?
What is the primary factor that determines the severity of beta thalassemia?
What is the primary factor that determines the severity of beta thalassemia?
What characterizes beta thalassemia major?
What characterizes beta thalassemia major?
Which finding is least likely in beta thalassemia minor?
Which finding is least likely in beta thalassemia minor?
What is often required for the management of pregnancies affected by thalassemia?
What is often required for the management of pregnancies affected by thalassemia?
What does hemoglobin electrophoresis reveal in a patient with beta thalassemia minor?
What does hemoglobin electrophoresis reveal in a patient with beta thalassemia minor?
Which group is more likely to have beta thalassemia trait?
Which group is more likely to have beta thalassemia trait?
Which of the following indicates a need for further screening for thalassemia during pregnancy?
Which of the following indicates a need for further screening for thalassemia during pregnancy?
What is a common clinical feature of beta thalassemia major?
What is a common clinical feature of beta thalassemia major?
What type of inheritance pattern is seen in compound inheritance with thalassemia?
What type of inheritance pattern is seen in compound inheritance with thalassemia?
Which complication is associated with alpha thalassemia major?
Which complication is associated with alpha thalassemia major?
Which is a common symptom of individuals with beta thalassemia minor?
Which is a common symptom of individuals with beta thalassemia minor?
What is the primary purpose of prenatal genetic diagnosis in thalassemia?
What is the primary purpose of prenatal genetic diagnosis in thalassemia?
What is a significant finding in the context of beta thalassemia major regarding life expectancy?
What is a significant finding in the context of beta thalassemia major regarding life expectancy?
Which factor contributes to the bone changes seen in patients with beta thalassemia major?
Which factor contributes to the bone changes seen in patients with beta thalassemia major?
What is the primary purpose of hemoglobin electrophoresis?
What is the primary purpose of hemoglobin electrophoresis?
Which type of hemoglobin should be present in the largest proportion in normal adults?
Which type of hemoglobin should be present in the largest proportion in normal adults?
What characterizes sickle cell disease?
What characterizes sickle cell disease?
What is the prevalence of sickle cell trait among African-Americans?
What is the prevalence of sickle cell trait among African-Americans?
What is the expected percentage of hemoglobin F in normal adults?
What is the expected percentage of hemoglobin F in normal adults?
Which condition presents milder symptoms compared to true sickle cell disease?
Which condition presents milder symptoms compared to true sickle cell disease?
What significant risk is associated with pregnancies affected by sickle cell disease?
What significant risk is associated with pregnancies affected by sickle cell disease?
What describes individuals who are heterozygous for the gene variant that produces hemoglobin S?
What describes individuals who are heterozygous for the gene variant that produces hemoglobin S?
What does hemoglobin S cause the affected red blood cells to do?
What does hemoglobin S cause the affected red blood cells to do?
What is the estimated prevalence of compound inheritance of both sickle cell and beta thalassemia?
What is the estimated prevalence of compound inheritance of both sickle cell and beta thalassemia?
Which hemoglobin type should normally have a percentage of less than 3% in adults?
Which hemoglobin type should normally have a percentage of less than 3% in adults?
What can be a consequence of sickle cell trait during pregnancy?
What can be a consequence of sickle cell trait during pregnancy?
What advantage is believed to be conferred by hemoglobin S in certain regions?
What advantage is believed to be conferred by hemoglobin S in certain regions?
How do the erythrocytes of sickle cell beta thalassemia compare to normal erythrocytes?
How do the erythrocytes of sickle cell beta thalassemia compare to normal erythrocytes?
What is the genotype for individuals homozygous for hemoglobin S?
What is the genotype for individuals homozygous for hemoglobin S?
What is the main reason why G6PD deficiency is often associated with populations of Mediterranean descent, Sephardic and Asiatic Jewish heritage, and African subgroups?
What is the main reason why G6PD deficiency is often associated with populations of Mediterranean descent, Sephardic and Asiatic Jewish heritage, and African subgroups?
In what way does G6PD deficiency impact the risk of urinary tract infections (UTIs) in pregnant women?
In what way does G6PD deficiency impact the risk of urinary tract infections (UTIs) in pregnant women?
What triggers the anemia symptoms associated with G6PD deficiency?
What triggers the anemia symptoms associated with G6PD deficiency?
What would be the initial step in the management of a pregnant woman with a suspected new diagnosis of G6PD deficiency?
What would be the initial step in the management of a pregnant woman with a suspected new diagnosis of G6PD deficiency?
Which of the following factors influence the severity of G6PD deficiency symptoms in pregnant women?
Which of the following factors influence the severity of G6PD deficiency symptoms in pregnant women?
What is the main clinical manifestation of G6PD deficiency in pregnancy?
What is the main clinical manifestation of G6PD deficiency in pregnancy?
What is the recommended screening frequency for asymptomatic bacteriuria and G6PD disease process in pregnant women with G6PD deficiency?
What is the recommended screening frequency for asymptomatic bacteriuria and G6PD disease process in pregnant women with G6PD deficiency?
Which of the following medications should be avoided in pregnant women with G6PD deficiency if a bacterial infection occurs?
Which of the following medications should be avoided in pregnant women with G6PD deficiency if a bacterial infection occurs?
What is the role of a midwife in managing a pregnant woman with a pre-existing diagnosis of mild G6PD deficiency in a population where G6PD deficiency is common?
What is the role of a midwife in managing a pregnant woman with a pre-existing diagnosis of mild G6PD deficiency in a population where G6PD deficiency is common?
What is favism, and what population is it most commonly seen in?
What is favism, and what population is it most commonly seen in?
Why might a woman with G6PD deficiency experience fatigue and dizziness during pregnancy?
Why might a woman with G6PD deficiency experience fatigue and dizziness during pregnancy?
What is the significance of understanding the episodic nature of G6PD deficiency?
What is the significance of understanding the episodic nature of G6PD deficiency?
If a woman with G6PD deficiency presents with jaundice and tachycardia during pregnancy, what would be the most likely cause?
If a woman with G6PD deficiency presents with jaundice and tachycardia during pregnancy, what would be the most likely cause?
What is the primary focus of antenatal care for a woman with a pre-existing diagnosis of G6PD deficiency?
What is the primary focus of antenatal care for a woman with a pre-existing diagnosis of G6PD deficiency?
What is the most important factor to prevent fetal growth abnormalities in pregnancies affected by G6PD deficiency?
What is the most important factor to prevent fetal growth abnormalities in pregnancies affected by G6PD deficiency?
Flashcards
RHD Antigen
RHD Antigen
Most common red blood cell antigen involved in isoimmunization during pregnancy.
Isoimmunization
Isoimmunization
Immunologic response leading to antibody production against red blood cell antigens.
Rh Negative Individuals
Rh Negative Individuals
People lacking the RHD antigen, at risk of isoimmunization in pregnancy.
RhoD Immunoglobulin
RhoD Immunoglobulin
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Inherited Anemias
Inherited Anemias
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Hemoglobinopathies
Hemoglobinopathies
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Thrombocytopenia
Thrombocytopenia
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Thrombophilia
Thrombophilia
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Hydrops fetalis
Hydrops fetalis
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Immune-related hydrops prognosis
Immune-related hydrops prognosis
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Fetal red blood cell transfusion
Fetal red blood cell transfusion
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Iron deficiency anemia
Iron deficiency anemia
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Heritable anemias
Heritable anemias
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Anemia diagnosis in pregnancy
Anemia diagnosis in pregnancy
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Physiologic hemodilution
Physiologic hemodilution
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Normal hemoglobin levels
Normal hemoglobin levels
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Red blood cell function
Red blood cell function
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Risk factors for heritable anemias
Risk factors for heritable anemias
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High blood volume consequences
High blood volume consequences
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Anemia effects on fetal development
Anemia effects on fetal development
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Perinatal outcomes and anemia
Perinatal outcomes and anemia
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Chronic tissue hypoxia
Chronic tissue hypoxia
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World Health Organization statistic on anemia
World Health Organization statistic on anemia
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Hemoglobin variants
Hemoglobin variants
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Hemoglobin F
Hemoglobin F
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Thalassemias
Thalassemias
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Alpha thalassemia
Alpha thalassemia
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Beta thalassemia
Beta thalassemia
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Autosomal recessive
Autosomal recessive
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Hemoglobin A
Hemoglobin A
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Alpha thalassemia trait
Alpha thalassemia trait
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Hemoglobin H disease
Hemoglobin H disease
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Silent carrier state
Silent carrier state
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Mean corpuscular volume (MCV)
Mean corpuscular volume (MCV)
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Hemoglobin electrophoresis
Hemoglobin electrophoresis
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Hemoglobin Barts
Hemoglobin Barts
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Iron deficiency exclusion
Iron deficiency exclusion
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Genotype variations
Genotype variations
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Rh Negative Blood Type
Rh Negative Blood Type
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Timing of Administration
Timing of Administration
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Kleinhauer-Betke Test
Kleinhauer-Betke Test
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Fetal Blood Mixing Events
Fetal Blood Mixing Events
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Dosage of RhoD
Dosage of RhoD
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Isoimmunization Risk
Isoimmunization Risk
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Antibody Screen
Antibody Screen
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Half Dose RhoD Products
Half Dose RhoD Products
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Maternal Fetal Transfusion
Maternal Fetal Transfusion
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Timing of RhoD Prophylaxis
Timing of RhoD Prophylaxis
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Sequela of Untreated Isoimmunization
Sequela of Untreated Isoimmunization
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Prenatal Fetal Diagnosis
Prenatal Fetal Diagnosis
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Sickle Cell Disease
Sickle Cell Disease
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SS Genotype
SS Genotype
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Sickle Cell Trait
Sickle Cell Trait
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Sickle Cell C Disease
Sickle Cell C Disease
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Maternal Mortality in Sickle Cell
Maternal Mortality in Sickle Cell
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Sickle Cell Beta Thalassemia
Sickle Cell Beta Thalassemia
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Perinatal Risks in Sickle Cell Trait
Perinatal Risks in Sickle Cell Trait
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Microcytic and Hypochromic Erythrocytes
Microcytic and Hypochromic Erythrocytes
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Thrombophilia Types
Thrombophilia Types
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Common Thrombophilias
Common Thrombophilias
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Risk of Thromboembolic Events
Risk of Thromboembolic Events
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Thrombophilia Testing
Thrombophilia Testing
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Anticoagulation Therapy
Anticoagulation Therapy
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DVT Symptoms
DVT Symptoms
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PE Symptoms
PE Symptoms
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Interdisciplinary Approach
Interdisciplinary Approach
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Fetal growth abnormalities
Fetal growth abnormalities
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Intrauterine growth restriction (IUGR)
Intrauterine growth restriction (IUGR)
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Anemia
Anemia
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Acquired anemia
Acquired anemia
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Hereditary anemia
Hereditary anemia
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G6PD deficiency
G6PD deficiency
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Favism
Favism
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Hemolytic anemia
Hemolytic anemia
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Episodes of anemia
Episodes of anemia
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Symptoms of G6PD deficiency
Symptoms of G6PD deficiency
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Higher UTI risk
Higher UTI risk
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Management of G6PD deficiency
Management of G6PD deficiency
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Screening for G6PD deficiency
Screening for G6PD deficiency
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Clinical care for G6PD
Clinical care for G6PD
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Gene carrier rates
Gene carrier rates
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Spherocytosis
Spherocytosis
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Inheritance pattern of spherocytosis
Inheritance pattern of spherocytosis
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Osmotic fragility test
Osmotic fragility test
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Elliptocytosis
Elliptocytosis
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Diagnosis of elliptocytosis
Diagnosis of elliptocytosis
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Qualitative vs Quantitative abnormalities
Qualitative vs Quantitative abnormalities
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Genetic counseling
Genetic counseling
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Folate supplementation
Folate supplementation
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Monitoring during pregnancy
Monitoring during pregnancy
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Hyper proliferative anemia
Hyper proliferative anemia
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Prenatal care for hemolytic anemia
Prenatal care for hemolytic anemia
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Complete blood count (CBC)
Complete blood count (CBC)
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Thalassemia Major
Thalassemia Major
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Thalassemia Minor
Thalassemia Minor
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Anemia in Beta Thalassemia Major
Anemia in Beta Thalassemia Major
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Hepatosplenomegaly
Hepatosplenomegaly
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Diagnosis of Thalassemia
Diagnosis of Thalassemia
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Iron Supplementation
Iron Supplementation
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Alpha Thalassemia Major
Alpha Thalassemia Major
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Thalassemia Carrier Incidence
Thalassemia Carrier Incidence
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Clinical Presentation in Pregnancy
Clinical Presentation in Pregnancy
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Management of Thalassemia in Pregnancy
Management of Thalassemia in Pregnancy
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Pre-eclampsia
Pre-eclampsia
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Asymptomatic Bacteriuria
Asymptomatic Bacteriuria
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Pyelonephritis
Pyelonephritis
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Folic Acid Supplementation
Folic Acid Supplementation
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Sickle Cell Crisis
Sickle Cell Crisis
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Thrombocytopenia Causes
Thrombocytopenia Causes
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Antiphospholipid Syndrome
Antiphospholipid Syndrome
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Fetal Surveillance
Fetal Surveillance
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Prenatal Genetic Counseling
Prenatal Genetic Counseling
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Low Dose Aspirin Therapy
Low Dose Aspirin Therapy
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IV Fluids in Crisis Management
IV Fluids in Crisis Management
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Study Notes
Hematologic Disorders in Pregnancy (Antenatal Care)
- Red Blood Cell Isoimmunization (RHD):
- Risk: Exposure to fetal red blood cell antigens can trigger maternal antibody production, crossing the placenta and harming the fetus.
- Risk Factors: Blood transfusions, previous pregnancies, organ/tissue transplants, and trauma with blood mixing.
- Rh Factor: Rh-negative mothers are at higher risk due to the prevalence of Rh-positive individuals.
- Prevention: RhoD immunoglobulin (Rhophylac, RhoGAM) is administered routinely to Rh-negative pregnant women.
- Timing: Late second or early third trimester (26-28 weeks gestation).
- Second Dose: May be needed following birth if baby is Rh-positive.
- Other indications: Abdominal trauma, amniocentesis/CVS, miscarriage/termination (beyond 4 weeks).
- Dosage: Standard 300 mcg IM (deltoid); half-dose formulations (150-200 mcg) less common.
- Quantification: Kleinhauer-Betke (KB) test to determine fetal red blood cell volume in maternal circulation; adjust dose if high volume.
- Exception: Both parents Rh-negative, as offspring will be Rh-negative.
- Time sensitivity: Most effective when administered within 72 hours of exposure.
- Antibody Screening: Essential for early detection, initially always negative but may show weak positive if administered RhoD prophylaxis in the past 14 weeks, and for monitoring antibody production.
- Severity: Primary isoimmunization rarely impacts current pregnancy; subsequent pregnancies are at highest risk, impacting fetal outcomes.
- Clinical Symptoms: Recurrent miscarriage, abnormal fetal growth, immune hydrops (fluid buildup in fetal tissues).
Inherited Anemias
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Definition: Lab values for diagnosing anemia vary in pregnancy; lower hemoglobin levels are expected in the second trimester due to physiologic hemodilution.
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Hemoglobin/Hematocrit: Standard serum tests reflecting iron levels. considered late indicators; Hereditary anemias often exist at lower baseline levels during pregnancy.
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Heritable Anemias: Chronic conditions worsened by pregnancy's physiologic adaptations; often diagnosed in childhood, with some presenting later (pregnancy can be presenting factor).
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Other factors Affecting Values: Long-term high altitude residence, cigarette smoking may elevate hemoglobin/hematocrit values. Race and ethnicity demonstrate variable hemoglobin levels. Capillary blood sampling can be less reliable. High values are not necessarily reassuring; may indicate poor blood volume expansion, possibly impacting fetal outcomes. Affected women at increased risk for poor perinatal outcomes, fetal growth restriction, and early pregnancy loss. High prevalence in certain ethnic groups.
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Specific Disorders:
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Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency:
- Inheritance: X-linked, more common in males.
- Protection: Potential protection against malaria; high prevalence in Mediterranean populations, Sephardic and Asian Jews, African subgroups.
- Severity: Episodic; anemia triggered by certain drugs/foods (oxidative stressors) or infections; heterozygous women can show varying degrees of mild to severe symptoms.
- Diagnoses: Avoid drugs that can cause induced hemolytic anemia; rule out other causes for anemia (e.g., iron deficiency, hemoglobinopathies) or symptomatic G6PD deficiency or other anemias with symptoms. Regular urine screens & cultures indicated.
- Clinical Manifestations: Intermittent anemia, fatigue, dizziness, tachycardia, jaundice, hemoglobinuria. Increased risk of UTIs in pregnancy; requires regular monitoring. Avoid oxidant medications (e.g., sulfonamides, nitrofurantoin) for infections in G6PD deficient women.
- Prenatal Care: Avoidance of triggering substances if known; consultation with physician suggested; partner screening in affected women, and notification to pediatric providers post-partum.
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Spherocytosis:
- Inheritance: Autosomal dominant, variable penetrance (predictability).
- Mechanism: Genetic defect causing spherical, fragile red blood cells.
- Triggers: Infection, trauma, or pregnancy can trigger hemolytic crisis.
- Diagnosis: Family history, complete blood count abnormalities, osmotic fragility test.
- Prenatal Care: Vigilant monitoring for hemolytic crises; folate supplementation recommended; genetic counseling helpful.
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Elliptocytosis:
- Inheritance: Autosomal dominant.
- Mechanism: Genetic defect creating elongated red blood cells.
- Severity: Generally mild; often undiagnosed.
- Diagnosis: Family history, complete blood cell count abnormalities; peripheral blood smear or osmotic fragility test.
- Prenatal Care: Baseline evaluation/q-trimester monitoring of red blood cell indices. Consultation and folate supplementation recommended.
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Hemoglobinopathies (thalassemias and abnormal hemoglobin structure):
- Mechanism: Result from abnormal hemoglobin variants. Some are benign; others cause severe pathology.
- Inheritance: Autosomal recessive for thalassemia; various for hemoglobin types.
- Alpha Thalassemia: Quantitative; affects alpha chain production; ranging from no symptoms to severe consequences dependent on the number affected genes. Severe types can cause stillbirth.
- Beta Thalassemia: Quantitative; affects beta chain production; ranging from no symptoms to severe consequences; beta major leads to severe anemia, bone marrow expansion, and eventual death by early adulthood. Beta minor presents as mild anemia.
- Diagnosis: Identifying a low serum/MCV; hemoglobin electrophoresis required; excluding iron deficiency anemia is crucial.
- Prenatal Care: Routine antenatal fetal assessment; monitoring and preventing fetal growth restriction, oligohydramnios; prophylactic/regular iron and folate supplementation recommended, genetic counseling and prenatal genetic diagnosis available.
- Severity: Severity depends on the affected genes' number (major or minor form) or the specific mutated hemoglobin (e.g., HbS).
- Compound Inheritance: Possible with thalassemia and/or sickle cell trait; this can lead to more complex diagnoses and outcomes.
- Sickle Cell Disease:
- Inheritance: Autosomal recessive; high prevalence in African-American populations.
- Mechanism: Abnormal hemoglobin (HbS) causing red blood cell sickling and occlusion.
- Symptoms: Anemia, vaso-occlusive disease, increased risk of infections.
- Prenatal Care: Increased risk for complications, including pre-eclampsia and UTIs; regular urine analysis and culture and sensitivity. Genetic counseling recommended.
- Sickle Cell Crisis: Close observation of maternal-fetal status; IV fluids, oxygen, pain management. Ongoing fetal assessment;
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Other Hemoglobin Variants: (e.g., HbC, HbE) usually milder than HbS; less concern during pregnancy, but still important to asses.
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Platelet and Clotting Disorders
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Thrombocytopenia: Low platelet counts (<150,000/µL); usually requires a clinically diagnosed lower threshold. Bleeding risk increases when platelet counts reach <50,000/µL. Various causes, including pregnancy-related conditions, autoimmune disorders, and hypertension.
- Prenatal implications: Affects mode of delivery & certain procedures; regional anesthetics might be contraindicated. Midwives (in consultation with physicians) manage uncomplicated cases.
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Antiphospholipid Syndrome: Autoimmune; antibodies against phospholipids increase risk of blood clots and complications during pregnancy (recurrent miscarriage, fetal growth restriction, pre-eclampsia) and require management by consultations of physicians. Intrapartum care includes anticoagulant medicines (e.g., heparin, low molecular weight heparin) and low-dose aspirin; Fetal surveillance (monthly ultrasounds & twice-weekly fetal testing) indicated.
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Thrombophilias: Inherited disorders causing increased risk of blood clots (e.g., factor V Leiden, protein C/S deficiencies).
- Prenatal implication: Anticoagulant therapy usually reserved for complicated cases (multiple mutations, personal or family history of blood clots) & routine care is largely for those with uncomplicated conditions. Increased surveillance during later stages of pregnancy for those with elevated risk. Midwives can care for uncomplicated cases.
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Thromboembolism: Venous blood clots (deep vein thrombosis [DVT], pulmonary embolism [PE]). Pregnancy increases risk; symptoms can be masked by common pregnancy discomforts, requiring specialist consultations for diagnoses.
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Treatment: Anticoagulation, supportive therapy. Interdisciplinary approach often warranted.
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