A. lron deficiency anemia.
C. Sickle cell anemia.
D. Sideroblastic anemia.
Sickle cell disease (SCD) is a devastating abnormality of red blood cells (RBCs) that results in circulatory impairment, tissue damage, infarctions, severe anemia, and life-threatening infections.
During pregnancy, SCD poses problems to both mother and fetus. Maternal problems can arise from chronic underlying organ dysfunction such as renal disease or pulmonary hypertension, from acute complications of SCD such as vaso-occlusive crises and acute chest syndrome, and from pregnancy-related complications.
In normal, iron-replete women, RBC mass should increase by 400–450 mL during pregnancy to support the 40%–50% increase in blood volume. This increase in RBC mass is not achievable in women with SCD. During pregnancy 50%–70% of women with SCD require at least one hospitalization and 30%–40% require transfusion. In one cohort, women with SCD were hospitalized an average of 6 days during pregnancy.
Women with SCD not only require transfusion, but also have frequently been transfused previously and, according to published reports, 20% to 50% of SCD patients are alloimmunized.Limited blood products are available to women who are alloimmunized and need transfusion, but the most serious consequence is the maternal risk of developing a delayed hemolytic transfusion reaction, which can be life-threatening.
Another potentially life-threatening problem is pulmonary hypertension. It affects 6%–11% of SCD patients and is especially morbid in pregnancy due to the increased cardiopulmonary demands of gestation. Although maternal mortality from pulmonary hypertension was previously reported to be 30%–50%, mortality remains in the range of 16%.