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does low platelets/haemoglobin and iron mean more likely to bleed too much?


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#1 mumaboo

Posted 20 January 2009 - 08:22 PM

Hi Girls,
as the title suggest, I have low haemoglobin (100 at last test 13 weeks ago) and low iron and platelets due to thalassaemia.  I am public and with my first birth had a lot of excess bleeding after the birth, and wasnt able to even stand for 5 days - kept fainting etc.
I just wanted to know if anyone can tell me does this mean I am more likely to bleed too much this time?? I am wondering if there is anything I can do to reduce my chances? And if I do, (I am a public patient) am I in my rights to ask for a blood/platelet or whatever they do transfusion?? I just dont want to be soooo exhausted again, that I couldnt lift my baby up at all.  This time I have a toddler to look after as well, and no family nearby to help me.  
Appreciate your thoughts/experiences as when I asked my Dr he said no - cant help with that.  Just wait and see.  I dont want to wait and see I want to be ok, and out of hosp ASAP after the birth!
thanks

#2 Melissam12

Posted 20 January 2009 - 08:36 PM

Hi there,

a low haemoglobin and low iron and platelets doesn't cause excess bleeding, it just means that your ability to withstand blood loss is not the same as it would be if your iron and haemoglobin levels were normal.

The fact that you bled last time means you're more likely to bleed this time - especially if you have interventions in your labour such as induction, augmentation, epidural, forceps or caesarean.  You can therefore reduce your chances of bleeding by avoiding the above things.

You can ask for a full blood count after birth and ask for a transfusion if you feel this is needed.  Also keep taking an iron supplement such as Fab or Floradix even after you have your baby.

Melissa.

#3 White-Lily

Posted 20 January 2009 - 08:39 PM

When i had my GD test they found i had extremely low iron and haemoglobin. I was put on an iron supplement which will fix up my iron levels and help with the haemoglobin.
Are you taking any iron supplements?
Not sure about the bleeding tho.

#4 mumaboo

Posted 20 January 2009 - 08:46 PM

Thanks Melissa,
I actually thought that having low platelet count meant your blood didnt clot as easiy - being more 'dilute' so to speak?? But that is good to know, and yes I had a lot of intervention last time, hoping not this time.  I will keep that in mind about asking for a fbc this time.  Last time I remember when the ob saw me the next day he said 'gee your as pale as a ghost - maybe you could have used some blood' and that was it.  But I was a so weak for weeks afterwards.
This time I already struggle with feeling so weak now, every morning I have to prop myself up on teh bench when making a tea etc, and not because the baby is squashing my diaphragm etc, as it is not.  I will of course continue to take the tabs etc, I have been taking massive doses for months though - to no avail. The thalassaemia maybe??
thanks again

Hi White lily,
sorry I missed your post - you must have been typing at the same time I was.
Yes I have been taking two ferro-gradumet tabs a day (a lot I know!) plus the blackmores gold pg tabs, for many months now.  Doesnt seem to be helping at all.
I know it does for most women, just not me for some reason.
I am considering the iron injections but have been told they are quite nasty and to stay away from them if you can.

#5 suz1

Posted 20 January 2009 - 08:52 PM

MCE - you are right that low platelets can cause bleeding - but it depends how low the count is.  They are important in the blood clotting process.  The low iron and haemoglobin won't increase your chances of bleeding.

Are you seeing a haematologist for your thalassaemia?  If so, what do they recommend?  

Also, are you taking your iron tablets with vitamin C or orange juice?  If you are taking Ferro-grad C it already has the vitamin C added, the vitamin C increases the amount of iron you absorb.

Suzanne

#6 Soontobegran

Posted 20 January 2009 - 08:55 PM

If you have Thalassaemia i think it would be preferable to go into your labour with your blood in better condition than it is.
Low platelets does reduce the clotting ability of your blood as evidenced after your last delivery.It also can affect your ability to fight infection.
Being a public patient should not make any difference and if your HB is lower than 10O and platelets lower than 150000 pre delivery then I would ask whether he would consider a transfusion before hand. Going into a labour with low platelets and low HB is not too sensible given your history.
You can't afford to be feeling as bad as you did last time as you also have another little one to look after so prevention is better than waiting and seeing.
Of course you can help now by taking iron supplements and a diet rich in iron, folate but these tend to not make too much difference when you have Thalassaemia.
Wishing you luck


* edit as I just realised that it has been 13 weeks since your last HB? Given the fact it was 100 back then I am surprised you have not had it repeated given the fact that HB is the oxygen carrier in your blood. I think I would give your doctor a little, not so gentle reminder of his responsibility to you and your baby.

Edited by soontobegran, 20 January 2009 - 09:12 PM.


#7 i-love-my-son

Posted 20 January 2009 - 08:58 PM

Platelets are the components of blood that cause it to aggregate and clot.  If you have low platelets, any bleed is going to bleed for longer as it will not clot.

Low iron means (I think) that the production of red blood cells will be impeded.  You should continue to be on iron supplements to help remedy this.

Your experience after birth sounds very like mine (I have some rogue possible disease that seems to lead to more bleeding) - I ended up with a PPH that left me with half the blood levels I should have had and needed 4 bags of blood transfused.

I would ask for platelets to be on standby in case of bleeding, also ask for a blood test both straight after birth and after a day or so (my post-birth blood test showed 2/3 blood levels (borderline for transfusions) but it was artificially inflated by being dehydrated after birth, the next blood test showed 1/2 blood levels).

You may need to insist on blood tests (I had to insist as the ob dismissed my concerns and actually only agreed to the second test by saying "Oh, if it will make you feel better, we'll get another test done" ... followed a couple of hours by "oh gee, you really need a whole bunch of blood transfusions".  mad.gif

Your doctor sounds mildly useless, I would switch to someone else.  Blood loss can be very dangerous!!!  What if you fainted while holding the baby or fainted and fell into a position that cut off your air supply?

#8 3_for_me

Posted 20 January 2009 - 09:50 PM

I had low platelets due to thrombocytopenia.  I'm not sure how the low platelets in thallasemia work but with me atleast a short dose of steroids in the days before birth will up the blood platelet levels substantially and for only a few days shouldn't make any difference to bubs, might be worth discussing this with your doc.  Personally it sounds to me like your doc hasn't got much experience with high risk pregnancies, I am also surprised they aren't keeping a closer eye on your blood levels.  I would go high dose iron plus C as PP suggested for the anaemia, ferro-grad C is very good, I suggest taking it with OJ with a spoonful of benefibre in it as it will clog you up pretty good which you definately don't want going into labour.


I believe that they are happy for you to have a VB as long as your platelet levels are atleast 90 (varies a little depending on the hospital) any lower than this and you are generally considered too high risk andyou should have a c-section so definately find out ways to up your platelets.  It would be a good idea tosee a specialist in blood disorders if theOB is struggling with the concept

I

#9 BlondieUK

Posted 20 January 2009 - 10:57 PM

If yu want to know about low pletelts, have a look at the web page of the American College of Hematology. They have some very useful articles on the standard of care for patients with thrombocytonpenia.

PLatelets have nothing to do with your ability to clot (that's the red blood cell's job). They form the first line of defence (pre-clotting) against bruises and bleeds. So, if you scab your knee, before the scabv forms, you get kind of a clear film over the wound? THat's the platelets.

Anything over 50 (50,000, commonly referred to as '50' of a full blood count) is safe for a VB. For an epidural (and hence, a CS, there are varying limits - most hospital will not do an eip unless you have platelets >80, and prefer a count of 100. Having a spinal is a slightly lesser risk. This is because either an epi or a spinal has a small risk of bleeding insode the spinal cavity. At best, this can cause headaches - at worst, paralysis, which can be permanent - VERY rare!).

Have a look at these pages.

http://emedicine.medscape.com/article/272867-overview
http://www.hematology.org/policy/guidelines/idiopathic.cfm

These have up-to-date care practices.


I agree - it doesn't sound like your doctor knows much about thrombocytopenia in pregnancy. A 'normal' plateley count is upwards of 150. Anything above 100 is consiered quite normal in pregnancy. Anthign under that is a worry.

Low platelets do not have anything to do with your body's ability to fight infection. Thrombocytopenia is often a side effect of an underlying immune disorder, such as Lupus.

I have thrombocytopenia as a side effect/clinical symptom of Lupus. I have dealt with low platelets for both pregnancies, and I am more than happy for you to PM me with any questions.

#10 3_for_me

Posted 20 January 2009 - 11:12 PM

Actually platelets do form an important part of the clotting process.  They form a kind of 'web' (sorry not sure how else to describe it) in the wound which red blood cells then become trapped in.  Without enough platelets that 'web' is unable to form sufficiently and as a result the red blood cells flow freely and aren't trapped.

I had ITP for many years which wavered around the 30-50(000) mark, eventually in 2001 it dropped to 9(000), it should be between 150-400(000).  At that point I was considered at serious risk of a fatal bleed and my spleen was removed.  In thrombocytopenia atleast (sorry not so up on thallasaemia) the body 'reads' markers on the platelets as foriegn bodies and attacks them much like it would bacteria.  This filtering out of the platelets occurs in the spleen resulting in an enlarged spleen at the acute level, by removing the spleen this removal of the platelets no longer takes place and platelet levels return to normal (mine now hover around 400(000)).   Common treatment fo low platelet levels below about 30 includes steroid (hydrocortisone) treatment as below that level the risk of bleeding is serious.

#11 Soontobegran

Posted 20 January 2009 - 11:15 PM

QUOTE
PLatelets have nothing to do with your ability to clot (that's the red blood cell's job). They form the first line of defence (pre-clotting) against bruises and bleeds. So, if you scab your knee, before the scabv forms, you get kind of a clear film over the wound? THat's the platelets.



Sorry but this is very wrong. Platelets DO provide a vital part of haemostasis as reported in the link you provided.

It is not solely responsible, however, an integral part.
The OP has THALASSAEMIA and ot Thrombocytapaenia which creates a different set of problems which are a genetic issue rather that auto immune.

Edited by soontobegran, 20 January 2009 - 11:19 PM.


#12 3_for_me

Posted 20 January 2009 - 11:30 PM

I was under the impression though that thallasaemia was a genetic condition affecting the red blood cells only, which would suggest that the platelet issue was seperate?  Maybeyou could expand a little on your particular situation OP?

#13 Soontobegran

Posted 20 January 2009 - 11:55 PM

Hi Erinsmith,
I believe that the abnormal red blood cells in Thalassaemia produce excess thrombin which ativates abnormal platelet activity.
Cheers

#14 3_for_me

Posted 20 January 2009 - 11:58 PM

Awesome, thanks soontobegran, there are so many types of thalasaemia too, there had to be something I was missing original.gif

#15 Soontobegran

Posted 21 January 2009 - 12:09 AM

No problems original.gif You are so right. It was one of those subjects that i needed to revise over and over and over before I got it.

#16 threebillylids

Posted 21 January 2009 - 12:25 AM

This is one of the most dangerous threads I have read. This is a complex medical problem, with chronic long term management required, complicated with a pregnancy and associated changes. Some great suggestions and some dangerous ones. The OP should have an excellent understanding of her condition and great support network from the various medical appointments (including Specialists). So I am a bit amiss as to how she can decipher good information from bad. This forum is inappropriate to seek advice from general well wishing people. I know many will have the knowledge out there (as I do too) BUT without a comprehensive medical history we all can be walking on very dangerous ground in giving advice to the OP who has a complex history to consider for the well being of herself and her unborn child.

Just some words of warning.

#17 babblefish

Posted 21 January 2009 - 05:53 AM

aside from all the great advice here i would add that active third stage management may be something to discuss with MW or OB. i had low iron/haem and bleed a bit after last birth, and aside from usual iron tablets, the middie offered 'active management' to reduce my uterus quickly. (using oxytocin to expel placenta, and shrink uterus). she will monitor me, and we will use if she is suspicious of more bleeding.

something to ask about.

good luck, and insist on your rights to quality care!

#18 BlondieUK

Posted 21 January 2009 - 09:09 AM

The PPs are correct the platelets form an important defence against bleeding, but this is not clotting. They are two separate (though, related) functions.

This is why (in my circumstances) I am at risk both a a bleed due to low platelets, and at a high risk of blood clots (due to other factors).

I didn;t address the thalasssaemia, as I have no knowledge about this condition, other than that it involves a genetic factor.

threebillylids - I don;t see anything dangerous. There is information, but no one has suggested a course of action other than to seek better medical advice.

Different people here have low platelets for different reasons. We donlt know why the OP has low platelets, and this is something her doctor should be checking out. She may have ITP (idiopathis, or unexplained, low platelets), she may have PG induced thrombocytopenia, or she may have an underlying disorder. It is crazy that she has this cluster of symptoms (all of which can have adverse affects in PG and birth) and that her doctor isn't investigating further.

#19 Soontobegran

Posted 21 January 2009 - 07:02 PM

QUOTE
This is one of the most dangerous threads I have read. This is a complex medical problem, with chronic long term management required, complicated with a pregnancy and associated changes. Some great suggestions and some dangerous ones. The OP should have an excellent understanding of her condition and great support network from the various medical appointments (including Specialists). So I am a bit amiss as to how she can decipher good information from bad. This forum is inappropriate to seek advice from general well wishing people. I know many will have the knowledge out there (as I do too) BUT without a comprehensive medical history we all can be walking on very dangerous ground in giving advice to the OP who has a complex history to consider for the well being of herself and her unborn child.

Just some words of warning.




Thank you but your warning is not required.
I want to know just what it is that has been said other than advising the OP to speak to her doctor about her options regarding management of possible repeat Post partum haemorrhage due to her condition and her haematology results.
The OP will be well aware of her life long condition, the limitations and possible complications that may arise because of it.
She asked for support as to whether we thought she should try to get her doctor more interested in her previous history, her low HB and platelets.
NOWHERE has anyone given her any advice dangerous or otherwise--other than to suggest she talk to her doctor or change doctors if she got nowhere with her present one.
The discussion that was aside from this regarding platelets in no way could be taken as advice for her--it was banter between members and the OP would have been well aware of this.

QUOTE
The PPs are correct the platelets form an important defence against bleeding, but this is not clotting. They are two separate (though, related) functions.



Hi BlondieHK,

I am truly sorry but at the risk of sounding pedantic, I just want to say that a blood clot is formed by a plug of platelets and a network of insoluble fibrin molecules.
So platelets are important in haemostasis.
You are right in saying that clotting is a complicated sequence of events which is definitely affected by disorders such as your and the OP'S. I do hope that both of you are as well as you can be.
Cheers

Edited by soontobegran, 21 January 2009 - 07:03 PM.


#20 wrappedup

Posted 21 January 2009 - 07:10 PM

My daughter had ITP (low platelets) when she was two.  They were so low she had to be kept on a hospital bed and receive transfusions. She, effectively, had lost her ability to clot and would bleed out if she was hurt.  She had weekly blood tests for months, had to wear a helmet to play and neither she, nor her younger sister could go to childcare for months because of the risk of her getting ill and her platelets dropping further.

OP, I wouldn't muck with low platelets.  I would be seeking medical advice immediately.  Perhaps they will not be low enough to be of concern, but with a previous bleed behind you I would not muck around.  

All the best.

#21 Lishl

Posted 21 January 2009 - 08:03 PM

Hi

I am not sure I can really answer your question about bleeding but want to say that I too have thalassemia. From memory in my last pregnancy my blood count dropped to about the same, or just under 100 in the last stages of pregnancy. I recall my Ob telling me there isn't anything she could do to increase the blood count as such but she did recommend I have the needle (sorry, I can't remember what it is called) after labour to help reduce bleeding. I'm sorry, I can't remember the needle but it was what everyone can have after labour to speed the last part of labour up I think.
She did say that she'd just have to monitor how much blood I lost during labour but that I would have to lose alot to cause concern.
Perhaps you should push to speak to a doctor or midwife more about it prior to going in to see what you can do or at least so they are aware.
good luck, I hope you don't get too tired as I know what it can be like with thalassemia. Try not to stress too much.
x

#22 mumaboo

Posted 21 January 2009 - 08:25 PM

Hi ladies,
wow you are all a bunch of knowledge, which is why I asked the question here in the first place  original.gif .  Actually I dont really know that much other than what I have googled here about thalassaemia, and I only found out I have it in the last couple of years.  The reason I was asking was to see whether I was on the wrong track about whether I could take any precautions etc re: blood loss, as the Dr basically said no to my concerns.  Infact, quote" there is nothing we can do to plan for it, and nearly every woman is anaemic with low platelets as that is pg for you'.  Fact is, I did ask my midwives about it prior to seeing the Dr, and looked up my last birth details and agreed with me, and said I should have a plan of action, and also the injection to help the utuerus contract faster and thereby hopefully reduce bleeding.  But when I mentioned what the midwives had suggested, the Dr just blew me off and said no....(being a public patient you get to see a different dr each time, so not helpful there either)  I am going to request a another bt at next appointment as I really do feel so weak and crap already.  And I am going to see if I can insist on the injection etc too.  

It has helped me immensly to hear from you all, and I am glad you have all pretty much encouraged me to push for better care.  

I will also ask for a bfc after birth and if I am still in hosp the day later then too.  Good idea, cant hurt to check.  

thanks again wonderful women!  original.gif

#23 rodent

Posted 21 January 2009 - 08:30 PM

It was my understanding that taking iron tablets with thalessemia may not actually have any effect on the levels??  I would have thought the low platelets could affect bleeding at the time the placenta comes away though.  I really think you need to speak to your dr more thoroughly about it, seems some of your issues aren't being addressed adequately.  

I don't know if I have thalessemia or not, one of them (can't remember if it was alpha or beta) was negative but the other was inconclusive but has not been retested.  At 7 weeks my hemoglobin level was 104 which is the highest it has been in YEARS (it was 83 before I had my last son, I hate to think what it was after he was born).  I take iron supplements but they've never had any impact on my levels.  Trying spatone to see if it makes any difference this time but plan to ask for a retest of levels at my next appointment.

--Rodent

#24 nellymac

Posted 21 January 2009 - 08:36 PM

Hi mce,

After reading your post, I felt I needed to reply to tell you a bit about my problems with anaemia and pregnancies.

I have always been a bit anaemic, Hb sitting around 100. It had been investigated by a haematologist and I was told I had an anaemia of chronic disease, but the chronic disease was unknown.

When I fell pregnant with my first child, my first Hb at around 7 weeks was in the 90's.

My obstetrician wasn't too concerned and didn't really say much about it except ask about the outcome of the haematologist reviews I'd had previously.

I was exceptionally tired, but so is every pregnant lady, so just kept going.

At 20 weeks, my legs started to swell and I was exhausted.  I would get easily short of breath, palpitations and lightheadedness.  By 26 weeks, I had further routine blood testing which showed a haemoglobin of 79 with a severe haemolytic anaemia.  I was referred on to a different haematologist who did lots of tests and concluded I had an Unstable haemoglobinopathy, which meant, my red blood cells were being deformed by the 'stress' of pregnancy and my body was attacking and destroying them faster than I could make them.

After a few more weeks of struggling, the obstetrician finally decided to do something after I walked into his room and burst into tears, saying I couldn't cope anymore.

I was admitted to hospital and had 5 units of blood and felt so much better.  I had a growth scan which showed my babies growth had slowed dramatically due to the stress  the anaemia had placed on my body.

For the remainder of the pregnancy I had a blood count done twice a week and was transfused when my HB dropped below 90,  which initially was weekly, then fortnightly.

I had a top-up transfusion 2 days before an elective caesar, for other medical problems, and further blood tests at 2 and 5 days post caesar and another blood transfusion was needed at one month postpartum.

My DS was only 6 pounds at term.  He had been above the 50th percentile for growth on his 20 week scan.

My second pregnancy was much better managed.  I had blood transfusions every 4 weeks, when my Hb fell below 100, from 16 weeks and my DD was a healthy 7 1/2 pounds at delivery.

The reason I have told you all this is because clinically thalassaemia and haemoglobinopathy are similar.  They are both genetic problems, with distortion of the red blood cell globin chains due to stress eg pregnancy.

They can have bad outcomes in pregnancy, both for the mother and baby if not treated in a timely and proper manner by people experienced with their management. Obstetricians are not trained to deal with this sort of problem, but they should be willing to refer to other specialists who can help you.

You need to stand up for yourself and strongly ask to see a specialist haematologist now. Your issues need to be worked through and a plan made for the rest of your pregnancy and delivery.

Iron tablets can actually be detrimental in thalassaemia, unless you have proven iron deficiency. They will not treat the underlying cause of the anaemia which is an abnormal haemoglobin chain. Many doctors will just put anaemic people on iron replacement therapy, irrespective of the cause of the anaemia. More importantly to you is making sure you get a daily Folic acid of 5mg, as the high turnover of red blood cells depletes your body very quickly of Folate.

The low platelets is another issue that needs to be sorted out and again, the best person to see about that is a haematologist.

I hope by sharing my story I haven't worried you excessively.  I just wanted to let you know it can be managed well, if you seek help from the appropriate specialist.  You may not need transfusions, but I think at the very least someone should be monitoring your Hb levels regularly for you.

Wishing you strength as you deal with this.  I know how hard it can be.

#25 Soontobegran

Posted 21 January 2009 - 09:53 PM

Wow, you have had a really rugged time. I am so glad that you are able to share your experience with the OP and us. I think it proves that it is quite remiss of any doctor who does not investigate the possible consequences to the patient and the baby from anaemia and other haematological abnormalities.
Your little ones sure look healthy now.




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