hem1 - pacemaker

[ArchivalUser]

A 23-year-old woman at 8 weeks gestation is evaluated during a routine visit. Her history is significant for sickle cell disease for which she has had two hospitalizations for painful episodes. She also experienced a fetal loss 5 years ago during the third trimester of pregnancy. She is currently asymptomatic and performs all of the activities of daily living. The remainder of the history is noncontributory.

On physical examination, she is afebrile. Pulse rate is 88/min, respiration rate is 18/min, and blood pressure is 110/85 mm Hg. Pulse oximetry indicates oxygen saturation of 96% (room air). On cardiopulmonary examination, the lungs are clear, and a 2/6 early systolic murmur is heard over the left sternal border. The remainder of the examination is normal.

Laboratory studies indicate a hemoglobin of 5.5 g/dL (55 g/L), which is her baseline value, and a mean corpuscular volume of 95 fL.

Which of the following is the most appropriate transfusion strategy for avoiding fetal loss in this patient?

A Routine exchange transfusion to maintain the percentage of hemoglobin S <30%
B Routine transfusion to maintain hemoglobin >10 g/dL (100 g/L)
C Routine transfusion to maintain hemoglobin >7 g/dL (70 g/L)
D No transfusion required at this time

[ArchivalUser]

ddddddddddd

[ArchivalUser]

Hello pacemaker,

C..

[ArchivalUser]

hi Pacemaker and all the forum

i choose C

[ArchivalUser]

Hi guys


D)
Key Point
Routine blood transfusion during pregnancy in patients with sickle cell disease is not necessary unless mandated by other high-risk conditions.

Routine blood transfusion during pregnancy in patients with sickle cell disease is not necessary unless mandated by other high-risk conditions. Especially in underserved areas, fetal wastage and intrauterine growth retardation can be significant problems for many pregnant patients with sickle cell disease, which had previously been attributed to the effects of the anemia on the integrity of the fetal“placental unit. These problems have been linked to poor nutrition, such as iron or folate deficiency, or to a higher rate of other complications, such as preeclampsia, rather than to the direct effects of the anemia. Just as it does in cases of acute pain crises, transfusion may have deleterious effects on blood viscosity in the microvasculature and should be reserved for use in raising oxygen-carrying capacity.

Exchange transfusion is now used for acute events, such as chest syndrome, or to prevent recurrent stroke. Although pregnancy increases plasma volume”often disproportionately to the increase in red blood cell mass and leading to a decrease in hemoglobin”this condition does not require routine blood transfusion. Unless she experiences cardiovascular compromise or does not maintain adequate cell production as measured by the reticulocyte count, she does not require blood transfusion. She has been able to maintain all activities of normal living, and there is no history of cardiovascular compromise, frequent pain episodes, or central nervous system events that might require transfusion.