Haematogical problems in pregnant women at a general practitioner’s practice
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 5
Abstract
In normal pregnancy there are changes in a peripheral blood and coagulation and fibrinolysis systems. Of these, the most important are physiological dilutional anaemia, benign neutrophilic leucocytosis, benign thrombocytopenia, coagulation activation and fibrinolysis inhibition. A general practitioner must be familiar with these changes to diagnose correctly anaemia and thrombocytopenia, the two most common haematological abnormalities in pregnancy. As a criterion for anaemia in pregnancy, haemoglobin of < 11,0 g/dL in the first and third trimester, and < 10,5 g/dL in the second trimester, and < 10,0 g/dL after parturition are commonly used. Anaemia in pregnant women is mainly due to iron deficiency, an acute blood loss in the puerperium, and infrequently folate deficiency. Given increased alimentary iron absorption, oral iron supplementation is the most convenient, but its poor tolerance may be a problem. However, parenteral iron brings about a faster response. An availability of more and more safe iron complexes with sucrose and carboxymaltose allowed to use easier intravenous iron in pregnancy, practically even in moderate iron deficiency anaemia with haemoglobin of < 10 g/dL in the second and third trimester and the puerperium. Of thrombocytopenias in pregnancy, the most common is benign incidental thrombocytopenia, then thrombocytopenia associated with hypertensive complications of pregnancy and immunologic thrombocytopenia, which account for 74%, 21% and 4% of cases, respectively. Platelet count of < 100 x 109/L is a quantitative criterion for diagnosing immunologic thrombocytopenia. Besides anaemia and thrombocytopenia, we also consider thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, congenital disorders of plasma coagulation, and myeloproliferative neoplasm.
Authors and Affiliations
Tomasz Sikorski, Ewa Marcinowska-Suchowierska
Keywords
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