RhoD Immunoglobulin and Anemia in Pregnancy

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Questions and Answers

In which trimester is RhoD immunoglobulin routinely administered?

  • Any trimester
  • Third trimester (correct)
  • First trimester
  • Second trimester

What is the standard dose of RhoD immunoglobulin administered?

  • 300 micrograms (correct)
  • 150 micrograms
  • 500 micrograms
  • 200 micrograms

What is the purpose of the Kleinhauer-Betke (KB) test?

  • To identify potential complications in pregnancy
  • To monitor the efficacy of RhoD immunoglobulin administration
  • To determine the Rh status of the fetus
  • To quantify the volume of fetal red blood cells in the maternal circulation (correct)

What is an exception to RhoD immunoglobulin administration in pregnancy?

<p>If both parents are Rh negative (B)</p> Signup and view all the answers

When is RhoD immunoglobulin most effective?

<p>Within 72 hours of a potential exposure event (B)</p> Signup and view all the answers

What is the maximum volume of fetal blood that a standard dose of RhoD immunoglobulin can protect against?

<p>30 milliliters (D)</p> Signup and view all the answers

What procedures are commonly associated with the potential for maternal-fetal blood mixing?

<p>Amniocentesis and chorionic villi sampling (C)</p> Signup and view all the answers

Women with high hemoglobin and hematocrit values during pregnancy might experience which of the following?

<p>Increased risk of hypertension (D)</p> Signup and view all the answers

What is a potential impact of anemia on pregnancy?

<p>Decreased oxygen carrying capacity of maternal blood (D)</p> Signup and view all the answers

Which of the following is NOT a potential impact of anemia on pregnancy?

<p>Improved tissue oxygenation (D)</p> Signup and view all the answers

Which of the following is a potential cause of early labor initiation?

<p>Chronic tissue hypoxia (B)</p> Signup and view all the answers

How can heritable anemias impact pregnancy?

<p>Increase risk of recurrent early pregnancy loss (A)</p> Signup and view all the answers

What is the largest contributing factor to anemia during pregnancy?

<p>Iron deficiency (B)</p> Signup and view all the answers

Which of the following is a potential consequence of fetal hypoxia?

<p>Activation of the fetal hypothalamic pituitary adrenal axis (D)</p> Signup and view all the answers

What is the primary reason for the high percentage of maternal deaths attributed to anemia in developing countries?

<p>Postpartum hemorrhage (B)</p> Signup and view all the answers

Which of the following is NOT a potential factor contributing to intrauterine growth restriction?

<p>Adequate maternal blood volume (B)</p> Signup and view all the answers

What is a common finding in hemoglobin electrophoresis when diagnosing thalassemia?

<p>Elevated hemoglobin F (C)</p> Signup and view all the answers

What is a potential genetic consequence of an individual with alpha thalassemia mating with a partner who is missing a single allele?

<p>Hemoglobin H disease (C)</p> Signup and view all the answers

What is the primary management strategy for pregnancies affected by severe alpha or beta thalassemia?

<p>Perinatology management (A)</p> Signup and view all the answers

Which of the following statements is TRUE concerning individuals with beta thalassemia major?

<p>They often experience shortened lifespan despite transfusion therapy. (C)</p> Signup and view all the answers

What is the primary prenatal concern for pregnancies affected by thalassemia?

<p>Fetal hydrops (D)</p> Signup and view all the answers

Why is iron supplementation recommended for pregnant women with thalassemia, even if their red blood cell indices are normal?

<p>To prevent iron deficiency anemia (B)</p> Signup and view all the answers

What is the term for a person who inherits both sickle cell trait and beta thalassemia trait?

<p>Sickle cell beta thalassemia (C)</p> Signup and view all the answers

What is the most common inheritance pattern for spherocytosis?

<p>Autosomal dominant (B)</p> Signup and view all the answers

What is the recommended screening protocol for G6PD deficiency during pregnancy?

<p>Screening is not routinely performed, but is offered to women with a known diagnosis of G6PD deficiency. (C)</p> Signup and view all the answers

Which of the following is a prenatal care recommendation for pregnancies with thalassemia?

<p>Routine antenatal fetal assessment (B)</p> Signup and view all the answers

What is the typical outcome for fetuses affected by alpha thalassemia major?

<p>Severe fetal hydrops and/or stillbirth (A)</p> Signup and view all the answers

What is the main reason for recommending midwife consultation for women with G6PD deficiency?

<p>To provide specialized care and guidance on managing G6PD deficiency during pregnancy. (A)</p> Signup and view all the answers

Why is genetic counseling recommended for couples with a family history of thalassemia?

<p>To determine the risk of their offspring developing thalassemia (C)</p> Signup and view all the answers

How does G6PD deficiency affect red blood cells?

<p>It makes the red blood cells more susceptible to oxidative stress, leading to hemolysis. (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of spherocytosis?

<p>Its symptoms and severity are dependent on the consumption of certain agents. (A)</p> Signup and view all the answers

What is the typical course of treatment for G6PD deficiency during pregnancy?

<p>Avoiding triggers that can cause hemolytic anemia. (D)</p> Signup and view all the answers

Why is it important for midwives to notify pediatric providers about newborns born to mothers with G6PD deficiency?

<p>To coordinate care and ensure timely diagnosis and management of potential complications. (A)</p> Signup and view all the answers

What is the recommended diagnostic procedure for women presenting with unexplained anemia during pregnancy?

<p>G6PD deficiency testing. (D)</p> Signup and view all the answers

What is the primary concern for fetal health in women with G6PD deficiency?

<p>Increased risk of fetal anemia and hemolysis. (D)</p> Signup and view all the answers

Which of the following is a clinical manifestation of G6PD deficiency?

<p>All of the above. (D)</p> Signup and view all the answers

What is the primary concern regarding antiphospholipid syndrome during pregnancy?

<p>Increased risk of blood clots and adverse pregnancy outcomes (B)</p> Signup and view all the answers

Which of the following is NOT a common clinical manifestation of antiphospholipid syndrome?

<p>Gestational diabetes (A)</p> Signup and view all the answers

What is the typical approach to fetal surveillance for women with antiphospholipid syndrome?

<p>Monthly growth ultrasounds and twice weekly fetal testing starting at term (B)</p> Signup and view all the answers

In which scenario is anticoagulation therapy typically RECOMMENDED for women with thrombophilias?

<p>Women with a personal or family history of unexplained blood clots (C)</p> Signup and view all the answers

Which of the following statements BEST describes the use of thrombophilia testing?

<p>Mostly used retrospectively following a clotting event (A)</p> Signup and view all the answers

Flashcards

RhoD Immunoglobulin

A medication used to prevent Rh incompatibility in pregnant women with Rh-negative blood.

Timing of Administration

RhoD immunoglobulin is typically administered between 26 to 28 weeks of pregnancy.

Indications for Use

Used during birth or events causing maternal-fetal blood mixing, like trauma or amniocentesis.

Standard Dose

The standard dose of RhoD immunoglobulin is 300 micrograms via intramuscular injection.

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Kleinhauer-Betke Test

A blood test that quantifies fetal red blood cells in maternal circulation to guide RhoD dosing.

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Autosomal Recessive Inheritance

Both reproductive partners must be Rh-negative for offspring to be Rh-negative, eliminating the need for RhoD.

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Prophylaxis Timing

RhoD immunoglobulin must be given within 72 hours after potential exposure for best results.

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Normal Hemoglobin Levels

Hemoglobin value above 15 grams/dL or hematocrit above 45% indicates potential issues in pregnancy.

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High Hemoglobin Concerns

Elevated hemoglobin/hypotonicity can cause hypertension and poor perinatal outcomes.

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Anemia Effects

Anemia reduces maternal blood's oxygen-carrying capacity affecting fetus oxygen supply.

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Heritable Anemias

Anemia types that are genetic can lead to fetal growth restriction and early pregnancy loss.

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Maternal Deaths & Anemia

Up to 40% of maternal deaths in developing countries linked to anemia, particularly blood loss.

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Iron Deficiency Anemia

Most common form of anemia impacting pregnancy and perinatal health.

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Preterm Birth Risk

Anemia may increase a woman's likelihood of preterm birth due to oxygen deficiencies.

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Fetal Hypoxemia

Chronic low oxygen levels in fetus can lead to stress and early labor initiation.

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Anemia Classification

Anemia is categorized as acquired or hereditary, influencing health outcomes during pregnancy.

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Antiphospholipid Syndrome

An autoimmune disorder causing blood clots and pregnancy complications.

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Recurrent Miscarriage

Repeated unexplained pregnancy loss before 20 weeks.

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Thrombophilia

Inherited condition leading to increased risk of venous clots due to genetic mutations.

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Heparin Therapy

Anticoagulation treatment used in managing antiphospholipid syndrome during pregnancy.

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Fetal Surveillance

Monitoring of fetal growth and well-being during high-risk pregnancies.

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G6PD Deficiency

A genetic disorder affecting red blood cell function, leading to hemolytic anemia under certain conditions.

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Oxidant Medications

Medications that can trigger hemolysis in individuals with G6PD deficiency, including sulfonamides and nitrofurantoin.

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X-linked Inheritance

A mode of inheritance where the gene causing a trait or disorder is located on the X chromosome, affecting more males than females.

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Hemolytic Anemia

Anemia that results from the destruction of red blood cells, leading to a deficiency in their number.

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Spherocytosis

A genetic condition affecting erythrocyte shape, leading to fragile spherical red blood cells and hemolytic anemia.

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Partner Carrier Testing

Testing done to determine if a partner carries a genetic mutation that could affect fetal health, particularly in known conditions like G6PD deficiency.

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Fetal Growth Abnormalities

Anomalies in fetal development that may occur due to maternal health issues like new G6PD deficiency diagnosis during pregnancy.

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Pre-existing Conditions

Health issues that exist before pregnancy, which may complicate maternal and fetal health such as G6PD deficiency.

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Erythrocyte Membrane Defect

Genetic defects affecting the structure of red blood cell membranes, leading to conditions like spherocytosis.

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Clinical Care Guidelines

Protocols developed for managing specific health conditions, which ensure consistent and safe care.

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Hemoglobin A2

A type of hemoglobin increased in thalassemia, normally below 3.5%.

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Hemoglobin F

Fetal hemoglobin, typically greater than 2% in thalassemia patients.

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Thalassemia and infertility

Severe cases often lead to infertility in affected women.

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Prenatal care in thalassemia

Routine monitoring for growth and complications during pregnancy.

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Iron supplementation

Recommended to support hemoglobin levels in pregnancy.

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Folate supplementation

Used to enhance oxygen-carrying capacity of hemoglobin chains.

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Genetic counseling

Recommended due to the inheritable nature of thalassemia.

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Compound inheritance

Possibility of having multiple thalassemia traits, complicating the condition.

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Alpha major

Severe form of alpha thalassemia leading to sterility and fetal issues.

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Beta thalassemia major

Severe form resulting in reduced life expectancy and infertility.

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Study Notes

Hematologic Disorders in Pregnancy

  • Overview: This lecture covers potential hematologic complications in pregnancy, focusing on the antenatal period. Topics include RhD alloimmunization, inherited anemias (like G6PD deficiency, spherocytosis, elliptocytosis, and hemoglobinopathies), and conditions affecting platelets and clotting factors (thrombocytopenia and thrombophilia).

RhD Isoimmunization

  • Risk: Exposure to Rh-positive fetal red blood cells in an Rh-negative mother can trigger an immune response, potentially harming the fetus.
  • Prevention: Rho(D) immunoglobulin (RhoGAM or Rhophylac) is a blood-based product given routinely to Rh-negative pregnant women at 26-28 weeks gestation to prevent Rh factor isoimmunization. A second dose may be needed after delivery if the baby is Rh-positive. This prophylactic treatment can prevent potentially severe fetal effects.
  • Other scenarios: Maternal-fetal blood mixing can occur in other situations, such as: abdominal trauma, amniocentesis, chorionic villus sampling, miscarriages, and terminations. These scenarios also require RhoD immunoglobulin.

Inherited Anemias

  • Overview: These are chronic conditions that can affect pregnancy physiology, as physiologic adaptations can exacerbate pre-existing conditions. Often, these are first diagnosed during childhood, but can present during pregnancy.
  • G6PD Deficiency: A genetic disorder causing increased risk for hemolytic anemia triggered by certain medications or foods.
  • Sickle Cell Disease: Inherited disorder leading to abnormal red blood cell shape, causing various complications, including pain, organ damage, and increased risk for infection. It's imperative to assess for both the pregnancy and the inheritance, as it can affect the baby. Heterozygous (trait) is usually asymptomatic. Homozygous (disease) is typically life-threatening.
  • Thalassemia: Genetic disorder characterized by reduced or absent hemoglobin production, resulting in various complications including anemia and high risk for adverse pregnancy outcomes.

Other Hematologic Disorders

  • Spherocytosis: Heritable anemia that results in changes to the erythrocyte membrane structure, leading to fragile, spherical red blood cells, often precipitated by severe infection, trauma or pregnancy.
  • Elliptocytosis: Heritable anemia with mildly affected red blood cell shape, causing less severe symptoms than spherocytosis.
  • Thrombocytopenia: Low platelet count, resulting in bleeding problems.
  • Thrombophilia: Increased risk of blood clots.
  • Anemia: Low hemoglobin or hematocrit levels which are often associated with other conditions like pregnancy, chronic disease and even genetic conditions. Careful consideration of factors that can affect these measurements (like altitude and race) is important.

Management of pregnancy

  • Prenatal Care: Thorough screening, including antibody screens and hematocrit/hemoglobin checks, is important, and can identify potentially problematic conditions early.
  • Treatment: Appropriate management for conditions is tailored to the severity, the presence of related maternal or fetal issues, and the stage of pregnancy. Often, consultation with specialists such as neonatologists is necessary for those with severe conditions, especially in the case of homozygous variants.

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