Anaemia Hx by Howard H Coke

DEMOGRAPHICS - Age, religion, occupation, address

GRAVIDITY & PARITY

PC – Pregnant and pale/weak

HPC CHRONIC ILLNESSES – SCD and steady state, and follow-up. Fully
immunized. Thalassemia, HF, renal disease, pernicious anaemia,
resection of stomach, small bowel. Hx of heavy menses – fibroids,
blood in stool/melena, blood in urine/dark urine. SLE – malar rash,
joint pains.

RISK FACTORS - FHx thalassemia, SCD, renal disease, SLE. Past Obs
Hx of multiparity, poor spacing, poor nutrition (green veg and
beef/liver) and anaemia in previous preg. Fetal outcomes –
spontaneous abortions, prematurity, pre-term, IUGR, stillbirth,
perinatal D. Breast feeding and present health of children.

ANTENATAL HX – Booked early/late, BP, BMI. Blds – Hb Sc

electrophoresis, blood film. Partner’s blood type. 1 st trimester U/S -
Foetal no. and details of placental placement and. Haematinics.
Blood transfusions. Chorionic villus sampling. Pneumoccocal
vaccine administered. U/S after 24 weeks – details – abruption.
Bleeding. Contractions. Preterm passage of liquor. Follow up
frequency – every 2 weeks until 28 weeks – weekly thereafter.
Progress of anaemia, crises, thromboembolism, HTN and
proteinuria, infections (chest,renal) and therapies. Fetal well-being
and serial assessments on admission.

DETAIL OF HPC – Symptoms and severity – cardio, resp, cns, m/s. Hx

of exacerbating event – infection, hypoxia, acidosis, stress,
dehydration, cold.

RULING OUT DIFFERNTIAL – Previously ruled out in Hx

PAST OBS HX Same – details of spacing

GYNAE HX AND SEX HX Same

MENSTRUAL HX Details

MED HX Stated

FH Summary

SOC HX Details – Social and family support,

ROS IMP – Cardiac, Resp, CNS, General

Management Main Points

Maternal Well-being - Optimise – throughout pregnancy – haematinics (by 16 weeks) and Hb

assessment – Hb level of at least 10 g/dL with 60 % Hb A – blood transfusion
may be indicated

Prevent and treat crises aggressively if at risk – infection, infarction, etc –

well hydrated

Admit at term for induction of labour and delivery/complications – be sure

of dates (1st trimester U/S) – VAGINAL DELIVERY with epidural is the
preferred mode of delivery!

Post partum – increased risk of crises and thrombo-embolic phenomena

Combined OCP or progesterone only pills indicated for

contraception – sterilization is also an option

Fetal well-being - Prenatal diagnosis can be offered to couples at risk

Regular fetal monitoring – biophysical profiles

Neonatal diagnosis with gel elctrophoresis