ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI

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  1.  A 30-year-old pregnant female is undergoing routine blood tests . Pregnancy is associated with an increase in which of the following? A) Mean Cell Hemoglobin Concentration (MCHC) B) Serum ferritin concentration C) Hematocrit D) Total Iron Binding Capacity (TIBC) ✅ Answer: D) Total Iron Binding Capacity (TIBC) Explanation: Pregnancy leads to increased TIBC due to higher transferrin synthesis to compensate for increased iron demand. Serum ferritin and iron decrease due to increased iron utilization. Hematocrit reduces due to physiological hemodilution , not an actual decrease in RBC mass. DR MARIA RAFI ;923324747587 2.  A 28-year-old female, para 2+0 , presents with Hb 7 g/dL . What is the next best investigation? A) Hb electrophoresis   B) Total iron-binding capacity (TIBC) C) MCV and peripheral smear ✅ D) Serum iron Answer: A) Hb electrophoresis Explanation: The first step is to check MCV (Mean Corpuscular Volume) to classify anemia...
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Von Willebrand Disease (VWD) Type 3: References: RCOG Green-top Guidelines No. 71 (2017).

 

Von Willebrand Disease (VWD) Type 3: 

Classification and Inheritance

  • Type 3 VWD:
    • Severe quantitative deficiency of von Willebrand factor (VWF).
    • Associated with the most severe bleeding phenotype among VWD types.
  • Inheritance:
    • Autosomal recessive inheritance.
    • Genetic counselling is crucial to address risks of transmission and expression variability.

Risks in Pregnancy to Mother and Baby

  • Maternal Risks:
    • Significantly increased risk of antepartum, primary, and secondary postpartum haemorrhage (PPH).
    • Type 3 women are at higher risk due to very low or absent VWF levels.
  • Counselling:
    • Essential to inform patients about the heightened bleeding risks throughout pregnancy and delivery.

Prepregnancy and Antenatal Management

  • Pre-Conception:
    • Comprehensive assessment of bleeding phenotype and diagnosis review.
    • Multidisciplinary care approach required.
  • Testing:
    • VWF antigen, activity levels, and factor VIII levels checked at booking, third trimester, and before invasive procedures.
  • Management:
    • Referral to high-risk obstetric centres with haemophilia specialists.
    • Ensure facilities for laboratory monitoring of VWF and factor VIII levels.
    • Target factor VIII and VWF ristocetin cofactor (VWF:RCo) levels ≥0.5 IU/ml for invasive procedures.
  • Treatment:
    • DDAVP is not effective in Type 3 and should not be used.
    • Use VWF replacement therapy with plasma-derived concentrates containing both VWF and factor VIII.
    • Target peak VWF activity levels of 1.0 IU/ml and maintain ≥0.5 IU/ml until haemostasis is achieved.

Intrapartum Management

  • Treatment Timing:
    • Administer VWF replacement therapy close to delivery.
    • Monitor pre- and post-treatment VWF and factor VIII levels.
  • Additional Therapies:
    • Tranexamic acid can be given orally or intravenously.
    • Platelet transfusions may be needed in specific situations.
  • Delivery Mode:
    • Spontaneous vaginal delivery preferred if no other obstetric concerns.
    • Avoid fetal interventions such as fetal blood sampling (FBS), ventouse, and midcavity forceps to minimise trauma for at-risk neonates.

Analgesia and Anaesthesia

  • Neuraxial Anaesthesia:
    • Contraindicated due to the inability to correct haemostatic defects effectively.
  • Precautions:
    • Discussion with senior anaesthetist required for alternative pain management.
    • Avoid procedures with high bleeding risk unless VWF levels are corrected.
  • Medication:
    • Postnatal NSAIDs and intramuscular injections should only be used when VWF activity and factor VIII levels are >0.5 IU/ml.

Postpartum Management

  • Monitoring:
    • Maintain VWF and factor VIII levels >0.5 IU/ml for:
      • At least 5 days following caesarean or instrumental delivery.
      • At least 3 days following uncomplicated vaginal delivery.
  • Medications:
    • Prolonged administration of tranexamic acid may be required (e.g., 2–3 weeks or longer).
  • Awareness:
    • Patients should report delayed or excessive bleeding.
    • Regular haemoglobin monitoring is necessary.
  • Severe Cases:
    • Type 3 patients may need extended VWF concentrate therapy (2–3 weeks or longer postpartum).

Neonatal Management

  • Testing:
    • Cord blood samples for VWF activity must be taken at birth.
  • Vitamin K:
    • Administer orally unless VWF activity is confirmed normal.
  • Special Cases:
    • Routine cranial imaging recommended for neonates with Type 3.
    • Short-term prophylaxis with factor concentrate should be considered if delivery trauma is significant.

References: RCOG Green-top Guidelines No. 71 (2017).

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ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI

Image
  1.  A 30-year-old pregnant female is undergoing routine blood tests . Pregnancy is associated with an increase in which of the following? A) Mean Cell Hemoglobin Concentration (MCHC) B) Serum ferritin concentration C) Hematocrit D) Total Iron Binding Capacity (TIBC) ✅ Answer: D) Total Iron Binding Capacity (TIBC) Explanation: Pregnancy leads to increased TIBC due to higher transferrin synthesis to compensate for increased iron demand. Serum ferritin and iron decrease due to increased iron utilization. Hematocrit reduces due to physiological hemodilution , not an actual decrease in RBC mass. DR MARIA RAFI ;923324747587 2.  A 28-year-old female, para 2+0 , presents with Hb 7 g/dL . What is the next best investigation? A) Hb electrophoresis   B) Total iron-binding capacity (TIBC) C) MCV and peripheral smear ✅ D) Serum iron Answer: A) Hb electrophoresis Explanation: The first step is to check MCV (Mean Corpuscular Volume) to classify anemia...
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