HEMATOLOGIC DISORDER AND

PREGNANCY
NCM 109: MATERNAL AND CHILD HEALTH NURSING (HIGH RISK PATIENTS) | PROF
PERLIN ZELLAINE T. LICAS, RN, PhD, MAN

 Hematologic disorders during resulting from a combination of a

pregnancy involve either blood diet low in iron, heavy menstrual
formation or coagulation disorders. periods, or unwise weight-reducing
programs.
ANEMIA AND PREGNANCY
 Iron is made available to the body
Because the blood volume expands by absorption from the duodenum
during pregnancy slightly ahead of the into the bloodstream after it has
red cell count, most women have been ingested. In the bloodstream,
pseudoanemia in early pregnancy. This it is bound to transferring for
condition is normal and should be transport to the liver, spleen, and
focused with true types of anemia that bone marrow. At these sites, it is
occur as complication of pregnancy. incorporated into hemoglobin or
stored as ferritin.
This condition is normal and should not
be confused with true types of anemia TYPES OF ANEMIA
that occur as complications of
pregnancy. True anemia is typically
considered to be present when a
woman’s hemoglobin concentration is
less than 11 g/dl (hematocrit <33%) in
the first or third trimester of pregnancy
or when the haemoglobin
concentration is less than 10.5 g/dl
(hematocrit <32%) in the second
trimester. (Samuels, 2012)  Microcytic
 i.e., small red blood cell
 Hypochromic
A WOMAN WITH IRON-DEFICIENCY  i.e., less hemoglobin than
ANEMIA the average red cell
 SIGNS AND SYMPTOMS
 Iron deficiency anemia is the most o Extreme fatigue
common anemia of pregnancy, o Poor exercise tolerance
complicating as many as 15% to o Low birth weight
25% of all pregnancies o Preterm birth
(Chmielewska, Dziechciarz, o Restless leg syndrome (Willis-
Gieruszczak-Bialek, et al., 2016) Ekbom Disease)
 Many women enter pregnancy
with a deficiency of iron stores

PREPARED BY: ANDREA AMOR S. GABICA BSN 2B A.Y 2022-2023

Because the body recognizes that it  In women who are taking
needs increased nutrients, some women hydentoin, an convulsant agent
with this condition develop pica, or the that interferes with folate
craving and eating of substances such as absorption
ice or starch.  In women who have poor gastric
absorption, such as in those who
 NURSING MANAGEMENT have had a gastric bypass for
o Prenatal vitamins containing morbid obesity. (Pentieva, Selhub,
27 mg of iron
Paul, et al., 2016)
o Diet high in iron and vitamins
(green leafy vegetables, MEGALOBLASTIC ANEMIA (enlarged red
meat,, and legumes) blood cells)
o Take iron supplement with
orange juice  Because of the size of the cells, the
o Or vitamin C supplement, mean corpuscular volume will be
elevated in contrast to the lowered
which supplies ascorbic acid
level seen with iron-deficiency
anemia.
 Slow to progress, the deficiency
A WOMAN WITH FOLIC ACID-DEFICIENCY
may take several weeks to develop
ANEMIA or may not be apparent until the
second trimester of pregnancy.
 Full blown, it may be a contributory
factor in early miscarriage or
premature separation of the
placenta.

 SIGNS AND SYMPTOMS

o Lack of interest
 Folic acid, or folate or folacin, one o Shortness of breath
of the B vitamins, is necessary for o Weakness
the normal formation of red blood o Paleness of lower eyelids
cells in the woman as well as being o Paleness of tongue
associated with preventing neural o Paleness of hands
tube and abdominal wall defects o Low birth weight baby
in the fetus.
 Folic acid-deficiency anemia
occurs most often in multiple  NURSING MANAGEMENT
pregnancies because of the o Advised to begin
increased fetal demand. supplement of 400μg folic
 In women with a secondary acid
haemolytic illness in which there is o Eating folic-rich food (green
rapid destruction and production leafy vegetables, oranges,
of new red blood cells. dried beans)

PREPARED BY: ANDREA AMOR S. GABICA BSN 2B A.Y 2022-2023

 o Multivitamins preparations

A WOMAN WITH SICKLE-CELL ANEMIA

 Sickle-cell anemia is a recessively

inherited hemolytic anemia
caused by an abnormal amino
acid in the beta chain of
hemoglobin.
 If the abnormal amino acid
replaces the amino acid the amino
acid valine, sickling hemoglobin
(HbS) results; if it is substituted for HETEROZYGOUS
the amino acid lysine, nonsickling
 has only one gene in with the
hemoglobin (HbC) results.
abnormal substitution has occurred
 With this disease, the majority of
 Sickle-cell trait (HbAS)
red blood cells are irregular or
sickle shaped, so they cannot carry HOMOZYGOUS
as much hemoglobin as normally
shaped blood cells can.  has two genes in which the
 When oxygen tension becomes substitution has occurred
reduced, as occurs at high  Sickle-cell disease (HbSS) results
altitudes, or blood becomes more
viscid than usual, such as occurs
with dehydration, the cells clump  NURSING MANAGEMENT
together because of their irregular o Monitor woman’s nutrition
shape, resulting in vessel blockage intake
with reduced blood flow to organs. o Folic acid supplement
The cells then will hemolyze (i.e., be o Drinking at least 8 gasses of
destroyed), thus reducing the fluid daily
number available and causing a o Assess woman’s lower
severe anemia. extremities for varicosities or
 At any time in life, sickle-anemia is pooling of blood in leg veins
a threat to life if vital blood vessels o Sitting with the legs elevated
such as those to the liver, kidneys, or lying on the side in a
hearts, lungs or brain become modified Sims position
blocked. o Monitored fetal health by an
 In pregnancy, blockage to the ultrasound examination at
placental circulation can directly 16 to 24 weeks
compromise the fetus, causing low o Ultrasound examination
birth weight and can possibly fetal beginning at about 30
death. weeks
 THERAPEUTIC MANAGEMENT

PREPARED BY: ANDREA AMOR S. GABICA BSN 2B A.Y 2022-2023

 o Periodic exchange or blood
transfusions throughout
pregnancy
o Oxygen administration
o If caesarean section
epidural anesthesia is a
method of choice
o Early ambulation and
wearing of pressure
stockings or IPC boots
o Electrophoresis of red blood
cells obtained from
maternal serum or by
amniocentesis during
pregnancy can reveal the
presence of the disease on
the few β-hemoglobin
chains already present in
fetal life.

PREPARED BY: ANDREA AMOR S. GABICA BSN 2B A.Y 2022-2023