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17 - Blood disorders

from Section 5 - Other disorders

Published online by Cambridge University Press:  19 October 2009

By
M. Joanne Douglas  and
Penny Ballem
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
M. Joanne Douglas
Affiliation:
Department of Anesthesia, BC Women's Hospital, Vancouver, Canada
Penny Ballem
Affiliation:
Clinical Professor, Department of Medicine, School of Hematology, Faculty of Medicine, University of British Columbia, Victoria, BC, Canada
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Background

Normal hematological indices during pregnancy

Multiple changes occur to the hematological system during pregnancy as outlined in Table 17.1. It is essential that the clinician be familiar with these in order to determine what is normal and what is abnormal when reviewing laboratory results in the pregnant woman.

Hematological testing during pregnancy

A routine, complete blood count during early pregnancy (first trimester) is important to identify common, preexisting hematological disorders that may impact on the pregnancy. In the uncomplicated pregnancy, a repeat blood count in the third trimester is done to assess the hematocrit in preparation for delivery.

Coagulation screening is performed only:

  • to investigate a significant bleeding history

  • to follow factor levels in patients with established disorders

  • during acute peripartum complications such as preeclampsia, massive hemorrhage or disseminated intravascular coagulation (DIC)

  • to monitor anticoagulation therapy.

Screening assays include platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen (see Table 17.2). The subjective nature of the bleeding time as a measure of platelet function and its established lack of sensitivity and specificity as a predictor of clinical bleeding, has precluded its usefulness.

Currently, several centers use thromboelastography (TEG) to detect the risk of clinical bleeding; however, the sensitivity and specificity of this test remain unproven. Another point of care instrument, the platelet function analyzer (PFA-100®), is thought to represent an “in vitro” bleeding time.

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 293 - 320
Publisher: Cambridge University Press
Print publication year: 2008

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  • Blood disorders
    • By M. Joanne Douglas, Department of Anesthesia, BC Women's Hospital, Vancouver, Canada, Penny Ballem, Clinical Professor, Department of Medicine, School of Hematology, Faculty of Medicine, University of British Columbia, Victoria, BC, Canada
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.018
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  • Blood disorders
    • By M. Joanne Douglas, Department of Anesthesia, BC Women's Hospital, Vancouver, Canada, Penny Ballem, Clinical Professor, Department of Medicine, School of Hematology, Faculty of Medicine, University of British Columbia, Victoria, BC, Canada
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.018
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Blood disorders
    • By M. Joanne Douglas, Department of Anesthesia, BC Women's Hospital, Vancouver, Canada, Penny Ballem, Clinical Professor, Department of Medicine, School of Hematology, Faculty of Medicine, University of British Columbia, Victoria, BC, Canada
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.018
Available formats
×