2.16.1.1. If a patient presents with platelets under 150 or over 400 10x9/L, discuss with the area obstetric consultant for appropriate action. (This may just be to repeat FBC at 16 weeks if the result is borderline, or a direct referral to obstetrics/haematology).
2.16.1.2. Any patient with platelets below 100 should be referred to obstetrics/haematology.
2.16.2.1. If platelets 100-150 10 × 9/L, repeat FBC monthly and refer to obstetrics if platelets fall below 100. Home birth and Truro Birth Centre are acceptable locations for delivery as long as platelets >90 10 × 9/L and no suggestion of a pathological cause of low platelets, such as HELLP, liver disease, ITP etc.
2.16.2.2. If platelets <100 10x9/L but the patient is otherwise well, refer to ANC.
2.16.2.3. If platelets <75 10×9/L refer to HaemObs.
2.16.2.4. If there is suspicion of an acute pathological cause e.g. hypertension or other abnormalities on the blood tests, or the patient is unwell for any reason, refer to triage.
| Information Category | Detail of process and methodology for monitoring compliance |
|---|---|
| Element to be monitored | • Haemoglobin and ferritin at booking is measured and 28 weeks. • The diagnosis of anaemia is made if Hb is <120 at booking. • The diagnosis of anaemia is made if Hb is <115 at 28 weeks. • Haemoglobin measurements are reviewed and treated within 2 weeks. • Once iron is commenced the Hb and ferritin should be reviewed after 6 weeks. • After 34 weeks, patients with iron deficiency anaemia should be referred for secondary care review. |
| Lead | Sophie Haynes, Consultant Obstetrician. |
| Tool | Elements to be monitored will be recorded on an Excel document. |
| Frequency | Once in the lifetime of the guideline. |