As hematologists focused on women’s health, we’ve been seeing pregnant women who have iron deficiency, clotting, and low platelet counts.
For many years, it has been assumed that anemia during pregnancy is “normal.” Recently, it has become clear that iron deficiency is the main problem, occurring in as many as 25% of all pregnancies. Children born to iron deficient mothers have been shown to have impaired cognitive, motor, social, and emotional development.
The way to solve this is to identify and treat all women who have iron deficiency. This has been challenging because of lack of awareness among women and their physicians, and poor understanding about the how iron testing is different from hemoglobin testing.
Pregnancy is also associated with blood clots (deep venous thrombosis (DVT) and pulmonary embolism). Leg swelling and pain, the symptoms of DVT, should be evaluated promptly. Our hematology guidance includes testing to look for clotting tendency mutations, anticoagulant medications to “dissolve” blood clots, and maintenance medications to prevent more clots through the pregnancy.
Another common blood problem among pregnant women is low blood platelet counts. When this occurs during the final month of pregnancy, it’s usually a harmless condition called “gestational thrombocytopenia.” But in other instances, low platelet counts are immune-mediated, and require treatments. The goals are to keep the platelet count more than 50 throughout the pregnancy and more than 80 to ensure that epidural anesthesia is safe.
All three of these blood problems pose challenges for pregnant women, an provoke anxiety for their obstetricians. Sometimes women wind up having early delivery or a C-section because of these problems.
Recently, Heme Onc Call, the country’s only telemedicine-based hematology practice, was created to reform the way women’s health hematology is practiced. Pregnant women no longer need to visit an oncologist for low iron or to discuss clotting or low platelet counts. Instead, they schedule a next-day online appointment to discuss blood test results and related issues.
