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Pregnant Woman with Mother

HOW Issues

The following is a non-exhaustive list of ‘HOW issues’ and require a multidisciplinary approach to optimise patient care.

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Women with pre-existing haematological disorders which require specific management during pregnancy or impact on issues specific to women such as heavy menstrual bleeding or fertility

  • Increased venous thromboembolism risk

    • Inherited or acquired thrombophilia

    • Previous venous thromboembolism

    • Myeloproliferative neoplasm

  • Anticoagulation planning

    • Patient on long term anticoagulation

  • Bleeding disorders

    • Immune thrombocytopenia

    • Haemophilia

    • von Willebrand disease

    • Rare bleeding disorders (e.g. factor VII, XI deficiency)

    • Platelet disorder

  • Haemoglobinopathy/Red cell disorders

    • Sickle cell disease

    • Thalassaemia

      • Beta thalassaemia major

      • Beta thalassaemia intermedia

      • Haemoglobin H disease

  • Haematology malignancy


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Women with pregnancy-associated haematological conditions

  • Gestational thrombocytopenia (low platelets)

  • Neonatal alloimmune thrombocytopenia (NAIT) – low platelets in baby due to maternal antibodies

  • Haemolytic disease of the fetus and newborn (HDFN) – Rhesus disease

  • Pregnancy associated thrombotic microangiopathy

    • HELLP

    • Thrombotic thrombocytopenic purpura (TTP)

  • Acute postpartum haemorrhage

  • Anaemia

    • Iron deficiency anaemia (also a complication of heavy menstrual bleeding outside of pregnancy)

    • Megaloblastic anaemia with vitamin B12 and/or folate deficiency.

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Transfusion issues

  • History of haemolytic disease of the fetus and newborn (HDFN) in past pregnancies

  • History of neonatal alloimmune thrombocytopenia (NAIT) in past pregnancies

  • Rare blood groups [e.g., Bombay, Jk(a-b-)].

  • Red cell or platelet alloantibodies

  • Patients who decline transfusion of specific blood components (e.g. Jehovah’s Witnesses)

 

Women with haematological complications related to gynaecological treatment such as hormone associated thrombosis

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