Hematologic

Plasma Volume

Plasma volume increases by 50% during pregnancy due to increase in both red blood cells (RBCs) and plasma, but proportionately more plasma. This results in hemodilution.

■ Greater in multigravids than primigravids

■ Greater in multiple pregnancies than in single pregnancies

■ Positively correlated with birth weight

■ Increase in plasma volume is less in patients with recurrent abortions.

■ Advantage of increased circulating volume:

■ Helps to compensate for increased blood flow to uterus and kidneys

■ Reduces viscosity of blood and increases capillary blood flow

Red Blood Cells

■ Circulating RBC mass increases progressively during pregnancy:

■ By 18% in women not given Fe supplements

■ By 30% in women on Fe supplementation

■ Reticulocyte count increases by > 2%.

■ Mean corpuscular volume (MCV) usually increases.

Hemoglobin

■ Fetal Hgb (HbF) concentration increases 1 to 2% during pregnancy, secondary to an increase in the number of RBCs with HbF

Erythrocyte Sedimentation Rate

Erythrocyte sedimentation rate (ESR):

■ Rises early in pregnancy due to the increase in fibrinogen and other physiologic changes

■ An ESR = 100 mm/hr is not uncommon in normal pregnancy.

White Blood Cells

Neutrophils

■ Neutrophil count increases in T1 and continues to rise until 30 weeks.

■ Neutrophilic metabolic activity and phagocytic function increases.

Lymphocytes

■ Counts remain unchanged, but function is suppressed.

Platelets

Tubules are presented with increased quantities of urine because of the increased GFR.

Progesterone increases Na+ excretion, but its increase is balanced by effects of increased aldosterone, mineralocorticoids, and prostaglandins.

Platelet reactivity is increased in T2 and T3 and returns to normal at 12 weeks postpartum

In 8 to 10% of normal pregnancies, the platelet count falls below 150 x 103 without negative effects on the fetus.

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