Hematologic changes of pregnancy

Components
Other 3%
Protein 7%
Water 90%

Neutrophils Monocytes
Lymphocytes
Erythrocytes
Thrombocytes
Erythropoietin
Cellular Components

to form fibrin fibers

fibrinolysis

averages 1100 to 1600ml Total volume 4700ml to 5200ml ,
i.e.

30 to 50% above non pregnant , Fig.1

in plasma volume

the enlarged uterus & hypertrophied vascular system.
To provide an abundance

of nutrients and elements to support the rapidly growing placenta and fetus.
To protect the mother and in turn the fetus, against the deleterious effects of impaired venous return in the supine and erect positions.
To safeguard the mother against the adverse effects of blood loss associated with parturition.

5 days later
10 to 15% above at
3 weeks

Nl at 6 wks

nonpregnant iron supplemented
15 to 20% above nonpregnant not on iron supplement
Life

span slightly decreased
Erythropoietin levels increase by 50 %

during late 2nd to early 3rd trimester lowest Hgb at

28 to 36wks
Nearer to term Hgb increases
Anemia cut off point: <11 g/dL 1st and 3rd trimesters and < 10.5 g/dL 2nd trimester, for black Americans 0.8g/dl less

the effects of hemodilution
increased platelet consumption

incidental thrombocytopenia is characterized :
mild asymptomatic
occurring in the third trimester
without

any history
not associated with maternal, fetal, or neonatal sequelae and
spontaneously resolves postpartum
Platelet counts are typically >70,000/microL, with
about two-thirds being 130,000 to 150,000 microL

(5,110 to 9,900/mm)
•
2nd & 3rd
trimester, the mean is 8,500/mm3, Nl
(5,600

to 12,200/mm3
In labor, rise to 20,000 to 30,000/mm3,
largely due to increases in circulating segmented neutrophils and granulocytes
caused by the elevated estrogen and cortisol levels
Returns to normal with in 1 to 2 weeks

thromboembolic disease
venous stasis, vessel wall injury, and changes in the

coagulation cascade
Fibrinogen, factors II, VII, VIII, X, XII, and XIII increase by 20 to 200 percent
Von Willebrand factor increases
Antithrombin, protein C, Factor V and Factor IX levels remain unchanged or increase slightly
return to baseline by six to eight weeks after delivery

RL:
bolic disease complicating pregnancy. In Foley MR, Strong TH [eds]:

increases approximately 18 to 30 percent
hematocrit normally decreases during gestation

but not below 30 percent
Pregnancy is a hypercoagulable state increases in the levels of the platelets
majority of the procoagulant factors increase and
fibrinolytic system decreases and in some of the natural inhibitors of coagulation

edition
Williams Obstetrics,Cunningham, Leveno, Bloom, Hauth, Rouse, Spong, 23rd edition
Obstetrics normal

and problem pregnancies, Steven G. Gabbe,Jennifer R.Niebyl, Joe leigh simpson, 5th Edition




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