Abstract
Hematologic changes in pregnancy are common and can potentially lead to maternal and fetal morbidity. Here, we present various hematologic manifestations seen in pregnant women. Iron deficiency anemia (IDA) is the most common cause of anemia in pregnancy. Physiologically, the state of pregnancy results in increased iron demand. Iron deficiency is important to diagnose and treat early for better maternal and fetal outcomes. An algorithmic approach is used for the repletion of iron storage, starting with oral elemental iron daily and escalating to intravenous iron if necessary. Folate and cobalamin are necessary elements for deoxyribonucleic acid (DNA) synthesis, fetal growth, and maternal tissue development, and deficiency in these elements can be a cause for anemia in pregnancy. Thrombocytopenia is currently the second most common hematologic condition in pregnancy after anemia. There is a wide range of etiology for thrombocytopenia in pregnancy from benign to life-threatening causes that require prompt diagnosis and treatment. These conditions include gestational thrombocytopenia, thrombotic thrombocytopenic purpura, pregnancy-associated atypical hemolytic-uremic syndrome, and immune thrombocytopenia. Acquired bleeding disorders that can cause major complications in pregnancy include von Willebrand disease (vWD) and coagulation factor deficiencies. Women with vWD are at increased risk of pregnancy bleeding and postpartum hemorrhage. Pregnancy can also produce a physiologic hypercoagulable state, leading to life-threatening conditions like thromboembolism. Diagnosis, treatment options, and guidelines for the management of these conditions will be explored in this review.
Highlights
BackgroundPregnancy induces a number of direct and indirect physiological changes in women, and various hematologic manifestations have been described
Congenital and acquired bleeding disorders, such as von Willebrand disease (VWD), and acquired coagulation factor deficiencies can present with hemostatic challenges during various stages of pregnancy, with increased risk of bleeding and mortality [4]
A rare condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury is pregnancy-associated atypical hemolytic-uremic syndrome (p-aHUS) [52]
Summary
Pregnancy induces a number of direct and indirect physiological changes in women, and various hematologic manifestations have been described. A rare condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury is p-aHUS [52] This syndrome is triggered by pregnancy, in which genetically predisposed women develop hemolytic disease characterized by diffuse endothelial damage and platelet consumption. The common clinical presentation of p-aHUS is acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia [54], these features are observed in TTP, acute fatty liver of pregnancy, and severe preeclampsia with HELLP syndrome. Distinguishing between these syndromes is sometimes difficult, making the right diagnosis in a timely manner is imperative. A study by Beyer-Westendorf et al showed that the quality of data on the effects of NOAC exposure in pregnancy that are provided on request from manufacturers and drug authorities is inferior to the quality of data obtained directly from physicians, which indicates a need to improve exposure and outcome assessment in this important medical scenario [81]
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