“Children are our most valuable resource and are our future,” according to Herbert Hoover. In order to have children, we must have healthy mothers to bear and deliver those children. Pregnancy is, of course, a difficult time with physical changes and discomfort. However, sometimes pregnancy also brings life threatening physical changes for the mother. One of these is Thrombocytopenia, a disorder related to a low platelets count. It affects many women during the pregnancy. If not treated, it can cause preeclampsia and lead to death to the mother or fetus. Human reproduction is necessary for the continuation of the human race, but thrombocytopenia threatens the continued health of mothers. This makes thrombocytopenia very important and necessary disorder to study and investigate.
What is Thrombocytopenia?
Thrombocytopenia affects 6% to 10% of all pregnant women and, other than anemia, is the most common hematologic disorder in pregnancy (McCrae, 2010). The blood consists of three main ingredients: red blood cells, white blood cells, and platelets. Each plays an essential function to provide the human body with elements and protects the body against any exterior viral and infection. Platelets are responsible to help blood to clot. The deficiency or disorder of platelets lead to disease called Thrombocytopenia. This issue is diagnosed when platelets are less than 150,000 platelets per microliter of blood (Erkurt, et. al, 2012).
Thrombocytopenia is divided into three different stages by the number of platelets: mild (100,000-150,000/micro l), moderate (50,000-100,000/micro l) and severe (< 50,000/micro l) (Erkurt, et. al, 2012). It effects all ages and especially pregnant woman.
Symptoms and Causes
Thrombocytopenia leads to excessive ...
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... in place in delivery rooms to better sterilize the environment to eliminate viruses and infection which would further risk bleeding for mother or infant and thus lead to increased time in the NICU.
Works Cited
Erkurt, M.A., Kaya, E., Berber, I., Koroglu, M., Kuku,I. (June 2012). “Thrombocytopenia in
Adults: Review Article.” Journal of Hematology: Vol. 1, No. 2-3
Cohen, R., Garcia, C.A., Mena, D., Castellanos, M., Wu L.T. (April 2012). “Case Review: Idiopathic Thrombocytopenia Purpura.” Journal of Medical Cases: Vol. 3, No. 2.
McCrae, R.K. (December 4, 2010). “Thrombocytopenia in Pregnancy.” ASH Education Program Book: doi: 10.1182/asheducation-2010.1.397 vol. 2010 no. 1 397-402
Rajasekhar, A. MD, Gernsheimer, T., MD, Stasi, R., MD, James, A.H., MD (2013). American Society of Hematology: Quick reference: Clinical Practice Guide on Thrombocytopenia in Pregnancy.
We can organize information regarding this case study by using the Four Topics Method beginning with the Medical Indications. Maria, a 20-year-old female, has been involved in a motor vehicle accident. She has a history of Sickle Cell disease and is currently twenty-five weeks pregnant with her first child. Initially Maria presents with somewhat stable vital signs. She displays tachypnea, and complains of severe abdominal cramping as well as weakness, light-headedness and left shoulder pain. She is neurologically intact with lung sounds that are within defined parameters. Maria’s condition changes and she begins to display signs and symptoms of internal bleeding. This is a life threatening condition. The problem is critical and can be reversed with a transfusion and surgery. The goal of transfusion would be to replace blood loss and restore vascular volume and the goal of surgery would be to repair the bleed. If the bleed is corrected in a timely manner and without complication, the probabilities of success are somewhat high. There is no plan in place to account for therapeutic failure. Medical care in this instance could not only save the life of this patient but also that of her unborn child. Further harm to Maria and her baby could be avoided if she would agree to the treatment.
• Hemolytic disease of the newborn. Hemolytic disease happens when a mother 's disease fighting system (immune system) attacks her baby 's red blood cells. Proteins (antibodies) in the mother’s blood destroy the baby 's red blood cells. Two conditions can cause hemolytic disease:
Hemophilia is a rare bleeding disorder that slows the blood clotting process, which is not normal. Some people with Hemophilia may just have a little bit of “clotting factor” or no clotting factor at all (National Institute of Health [NIH], 2013). Clotting factor is a protein in blood that controls bleeding and they are needed the blood to clot normally. In order to help the blood clot, clotting factors work with “platelets” (National Institute of Health [NIH], 2013). Platelets are small blood cell fragments that form in the bone marrow, a tissue in the bones that is similar to a sponge. The functions of platelets have a very important role in blood clotting; the role of a platelet is to stick together (by the help of clotting factors) to block cuts, break on the carriers of blood (veins or arteries) throughout the body, and stop the bleeding when “blood vessels” (National Institutes of Health [NIH], 2013) are injured. Blood vessels are tube like structures carrying blood through the tissues and organs, like a vein, artery, or capillary. People with hemophilia do not have enough “clotting factor VIII or IX” (World Federation of Hemophilia [WFH], 2013) in their blood, which results to prolonged bleeding or oozing, meaning that bleeding can last longer (though, not faster) than usual after surgeries, accidents, or having teeth pulled out at the dentist. Clotting factor VIII, which can also be called as “anti-hemophilic factor” (AHF, for short) (Patient.co.uk, 2011), is a blood clotting protein that is necessary for humans to have. Clotting Factor IX is a protein that i...
Haemophilia is used to describe a collection of hereditary genetic diseases that affect a mammal’s body’s capability to control thrombogenesis. Thrombogenesis is the way in which blood clots which is an important role in haemostasis. Two common forms of haemophilia are A and B. (1) Someone with A (otherwise known as classic haemophilia), clotting factor VIII is does not exist enough or is entirely absent. A person with haemophilia B (otherwise known as Christmas disease), clotting factor does not exist enough or is also entirely absent. Those with the disorder do not bleed a lot they just simply bleed for a longer period of time. All people with haemophilia A or B are born with the disorder as it is a hereditary disorder and passed down through generations very few cases of haemophilia are not genetic and are therefore rendered a spontaneous gene mutation which is then passed down.
The changes in f8 and f9 gene are responsible for hemophilia A and B. the f8 gene codes for a protein called coagulation 8. This protein is responsible for the blood clotting process. After an injury blood clots protect the body by sealing off the area of injury. Mutation in the f8 and f9 gene can lead to the abnormal form of the protein. Also can lead to a reduction of the coagulation pro...
Maternal & Child Health Journal, 8(3), 107-110. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=14089739&site=ehost-live.
18. American College of Obstetricians and Gynecologists. Maternal serum screening. ACOG Educational Bulletin, 1996; no. 228.
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
March Dimes Foundation: Pregnancy and Newborn Health Education Center. Retrieved from http://www.marchofdimes.com/materials/teenage-pregnancy.pdf
Sepsis is a “cunning, insidious and non-specific illness” (Raynor, 2012) but progression can be rapturous with a sudden catastrophic circulatory collapse and mortality up to 50%. (Angus et al., 2001) Over five million cases arise per year of maternal sepsis, resulting in an estimated 62,000 maternal deaths globally (WHO, 2008) During the 18th and 19th century, puerperal sepsis resulted in 50% of maternal deaths over Europe (Loudon, 2000). The World Health Organisation (WHO) defined puerperal sepsis as ‘infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum, of which two or more of the following are present: pelvic pain, fever 38.5C or more, abnormal vaginal discharge, abnormal smell of discharge, and delay in the rate of reduction of size of uterus (less than 2 cm a day during the first 8 days)’ (WHO, 1992).
Cesarean birthing method can be voluntary as well as involuntary. When a cesarean is chosen in advance it is usually because the mother has a history of infection, which could be transmitted to the baby when it is delivered through the birth canal; the mother has severe to...
Jancárková, N., & Gregor, V. (2000). [Teratogens during pregnancy]. Ceska gynekologie/Ceska lekarska spolecnost J. Ev. Purkyne, 65(3), 188-194.
A lot of pregnancies have led to maternal mortality and maternal morbidity. This area of concern is often situated with MFM subspecialists, in order to reduce the rate of maternal mortality and maternal morbidity (Haywood, B., 2012). The Society for Maternal-fetal Medicine also strives to improve maternal and child birth outcomes by standards of prevention, diagnosis and treatment through research, education and training. (Schubert, K. & Cavarocchi, N., 2012) In order for MFM subspecialists to help reduce the rate of maternal deaths, they must receive adequate training and education, including research, which is very essential for treatment. The main focus of the MFM subspecialist is early diagnosis of fetal abnormalities, pathogenesis, and early diagnosis and treatment of pre-eclampsia and fetal growth restriction. In ...
If a pregnant female came into the ER and had a CBC ran showing a low platelets count,