HOW Issues
The following is a non-exhaustive list of ‘HOW issues’ and require a multidisciplinary approach to optimise patient care.
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Women with pre-existing haematological disorders which require specific management during pregnancy or impact on issues specific to women such as heavy menstrual bleeding or fertility
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Increased venous thromboembolism risk
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Inherited or acquired thrombophilia
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Previous venous thromboembolism
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Myeloproliferative neoplasm
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Anticoagulation planning
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Patient on long term anticoagulation
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Bleeding disorders
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Immune thrombocytopenia
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Haemophilia
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von Willebrand disease
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Rare bleeding disorders (e.g. factor VII, XI deficiency)
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Platelet disorder
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Haemoglobinopathy/Red cell disorders
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Sickle cell disease
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Thalassaemia
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Beta thalassaemia major
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Beta thalassaemia intermedia
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Haemoglobin H disease
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Haematology malignancy
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Women with pregnancy-associated haematological conditions
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Gestational thrombocytopenia (low platelets)
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Neonatal alloimmune thrombocytopenia (NAIT) – low platelets in baby due to maternal antibodies
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Haemolytic disease of the fetus and newborn (HDFN) – Rhesus disease
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Pregnancy associated thrombotic microangiopathy
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HELLP
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Thrombotic thrombocytopenic purpura (TTP)
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Acute postpartum haemorrhage
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Anaemia
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Iron deficiency anaemia (also a complication of heavy menstrual bleeding outside of pregnancy)
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Megaloblastic anaemia with vitamin B12 and/or folate deficiency.
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Transfusion issues
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History of haemolytic disease of the fetus and newborn (HDFN) in past pregnancies
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History of neonatal alloimmune thrombocytopenia (NAIT) in past pregnancies
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Rare blood groups [e.g., Bombay, Jk(a-b-)].
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Red cell or platelet alloantibodies
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Patients who decline transfusion of specific blood components (e.g. Jehovah’s Witnesses)
Women with haematological complications related to gynaecological treatment such as hormone associated thrombosis