133 - Anaemias and other hematological disesases during pregnancy
Autor(s): P. Doretto, P. Cappelletti
Issue: RIMeL - IJLaM, Vol. 6, N. 2, 2010 (MAF Servizi srl ed.)
Page(s): 133-42
The major hematological malignancies affecting pregnancy are anaemia and thrombocytopenia. The most common causes of anaemia in pregnancy, defined by WHO as hemoglobin concentration below 11 g/dL, are nutritional deficiency (iron, folate and vit. B12), bone marrow failure, hemolytic diseases (malaria, sickle cell disease), chronic blood loss (parasites) and underlying neoplasm. The main causes iron deficiency which can become a severe problem because it significantly increases the risks for the mother (premature birth, tiredness, reduced mental and physical performance, cardiovascular disease, mortality, transfusion requirement post-partum) and the fetus (low birth weight, mental retardation and risk of developing iron deficiency during the first four months of life). During pregnancy, there is an expansion of red cell mass and to a lesser extent in plasma volume according to maternal fetal placental unit growth. The result is a physiological hemodilution of still controversial meaning and increased demand for iron with depletion of deposits which should be considered for a proper diagnostic workup. In this situation, it is more reliable to assess the state of iron depletion with soluble transferrin receptor ra134 RIMeL / IJLaM 2010; 6 ther than ferritin. Thrombocytopenia affects approximately 10% of all pregnancies. It can occur alone and often clinically benign form or associated with systemic disorders, with significant morbidity, both specific to pregnancy (preeclampsia, HELLP syndrome) that non-specific diseases (thrombotic microangiopathy, LES, CID, antiphospholipid antibodies, viral infections). The most common form is gestational thrombocytopenia, or incidental benign form with platelet count usually not lower than 100.000/L, which should be differentiated from immune thrombocytopenic purpura and the physiological and modest reduction in platelet count that usually occurs in the third trimester of pregnancy.