/20

Thalassemia and sickle cell anemia questions- Maternal medicine Module part2

Please Enter Your Details!

1)

A 22-year-old Afro-Caribbean woman who is 30 weeks pregnant with known sickle cell disease
presents via A&E with a two-day history of progressively worsening cough, fever, excruciating
bilateral chest pain and shortness of breath. This is her first pregnancy and it has been uneventful so
far. She has had serial scans from 24 weeks of gestation, which have been normal.
Her observations are a blood pressure of 100/60 mmHg and pulse rate of 118 bpm. Her respiratory
rate is regular at 32 per minute and temperature is 38.2°C. Oxygen saturation is 84% on air, chest
auscultation reveals mild bilateral basal crepitations but no wheeze. There is no calf tenderness.

Investigations:
• white blood cells = 19.8
• haemoglobin = 93 g/l
• platelets = 325

What would be the most appropriate treatment for her?
• reticulocytes = 16.2%
• ESR = 35
• CRP = 80
• chest X-ray: PA view - pulmonary infiltrates were seen bilaterally
• VQ scan normal
• ECG sinus rhythm, 118 bpm

2)

29 yr old woman with sickle cell disease is 14 weeks pregnant. She ia seen by midwife to
discuss her booking blood tests. She is rubella immune, HIV negative, Syphillis negative and her Hb is
8.4 gm/dl.

A couple are anxious about the risk of their baby being born with an inherited autosomal
recessive condition. Their anxiety stems from the fact that their relative recently had a baby with an
autosomal recessive condition. They want to know what the most common autosomal recessive
condition worldwide is.

3) What do you tell them?

4)

A 28 yr woman with sickle cell disease is 16 weeks pregnant. She has been taking folic acid
since beginning of her pregnancy, now she has been advised to obtain a substance that is
prophylactic measure which she has not received in the last 12 months.

5)

A woman with known sickle cell trait attends an antenatal booking clinic, What antenatal
complication is significantly more common than uncomplicated pregnancies?

6)

A 34 year old woman with sickle cell disease attends for pre-conception counseling. To assess
her for chronic complications

7)

A 33 yr old woman with sickle cell disease presents to preconception clinic. She would like to
become pregnant and her partner has been already tested for sickle cell disease and negative. The
woman is taking a no of medications, and is advised to stop a perticular drug 3 months before
conception.

8)

Pregnant patient with thalassemia major who had history of splenectomy. Her platelet count is
660x10*9
Regarding her thromboprophylaxis all are true except;

9) Regarding anemia in pregnancy

10)

A 24-year-old woman with sickle cell disease is admitted forinduction of labour at 38 weeks gestation in her first pregnancy
that is otherwise uncomplicated. Three hours after commencement
of intravenous oxytocin, her oxygen saturation drops to
93%. What is the most appropriate immediate management?

11)

Pregnant patient in second trimester with thalassemia major, did not come for preconceptional
counselling. On liver ferriscan was found to have high iron overload.

12)

23 yr old woman with sickle cell disease is admitted to emergency dept with painful crisis.
Which analgesia should be avoided?

13) All contraception comes under Category 1 for sickle cell disease except;

14) Which infection is known to produce an aplastic crisis in people with sickle cell disease?

15) All are true about hemoglobinopathies except

16)

Pregnant women booking blood shows Hb 98gm/l decreased MCH,decreased MCV , serum
ferritin 50 (normal)

17)

A patient with beta thalassemia , known diabetic seen in preconception clinic. How we monitor
her diabetes in pregnancy?

The midwife on the postnatal ward asks you to make a thromboprophylaxis plan for a 21 yr old
woman who has underwent ceserean section for intrauterine growth restrictions. She is having
sickle cell disease and no other risk factors.

18) Which of the following is a correct plan for her?

19) All are true about hemoglobinopathies except

20)

. Pregnant patient with thalassemia major who had history of splenectomy. Her platelet count
is > 600x 10*

Your score is

0%