one of the most amazing moments for a
woman is when she finds out she's
pregnant or I guess I should say when
her brain finds out because her body is
already aware of it from several weeks
before so much so that by the time a
woman finds out that she's about to be a
mom her body has already undergone
several changes to prepare for that
growing baby one of the first and most
important changes that the body makes is
that it realizes that it needs more
oxygen which means that it needs more
red blood cells to carry the oxygen
within the blood and in order to do that
the level of a hormone called
erythropoietin called
Aris role erythropoietin have to
increase right and erythropoietin is
this hormone that stimulates a bone
marrow to increase production of red
blood cells and those levels don't
increase by just a little they increase
up to 50% in fact if the pregnant body
could have its way with things the
amount of red blood cells would increase
by something like 20 to 30 percent over
the course of a pregnancy but what
actually ends up happening a lot of the
time in pregnancy is that women become
anemic so the hemoglobin and the
hematocrit values which are which are
measures of the amount of red blood
cells you have in the blood decrease
instead of increasing they decrease and
that can happen for a couple of
different reasons the first reason is
something that happens in normal
pregnant women and that is that the
plasma volume which the plasma is is
like the liquid component of blood the
plasma volume increases more than the
red blood cell mass so even though the
amount of red blood cells is increasing
the concentration of red blood cells in
the blood is decreasing does that make
sense so that's the first thing and it's
called a physiologic it's called a
physio physiologic physiologic anemia
because it's a part of normal pregnancy
physiology now another thing that can
happen is a true anemia or a
pathological process not a physiologic
process but a pathological process in
which there's an actual decrease in the
number of
blood cells so here and we're not
talking about concentration we're
talking about a decrease in the actual
number of red blood cells most commonly
that anemia the true anemia is due to a
shortage of iron in the body so iron is
used to make hemoglobin it's an
essential part of hemoglobin and red
blood cells are basically packets of
hemoglobin so no iron means no red blood
cells it's kind of like if you're going
to go make chocolate chip cookies and
you want to make let's say 100 of them
and you have enough of all of the
ingredients to make 100 cookies but you
only have enough chocolate chips to make
80 cookies so guess what you're going to
end up with only 80 chocolate chip
cookies so why the shortage of iron why
is there a shortage of iron in pregnancy
well these women the pregnant women are
by definition I guess women of
reproductive age right so they were
probably menstruating before becoming
pregnant and that blood loss that occurs
with each menstrual cycle claimed some
of the body's iron stores so that's one
cause for the iron shortage in pregnancy
another cause is that in trying to make
its own red blood cells the fetus claim
some of moms iron stories now iron
deficiency is by far the most common
cause of anemia in pregnancy so much so
that if a woman is a pregnant woman is
fine to be anemic she's usually treated
with iron supplementation and only and
only if that doesn't resolve the anemia
the supplementation doesn't result in
Mia do we go looking for another cause
alright so speaking of other causes it's
worth mentioning that folic acid
deficiency so deficiency of folic acid
right can also less commonly cause
anemia and pregnancy as can other causes
all the other regular causes of anemia
and something that happens particularly
in pregnancy is that the lifespan of a
red blood cell decreases so the red
blood cell doesn't quite live to be 120
days old before dying and this further
contributes to the anemia that we tend
to see in pregnancy so I want to make
the point that anemia isn't a problem
that's unique to pregnant
and you probably already know that but
anemia does have some unique
implications in pregnancy that it
doesn't have in other people for example
it can it can lead to things such as a
reduction in amniotic fluid levels in
the fetus right it can cause concerning
fetal heart tones or fetal heart
tracings it can lead to spontaneous
abortion low birth weight of the fetus
and even death of the fetus so so it can
be a pretty serious problem in pregnancy
now there's another important change
that occurs in the blood system of the
mom during pregnancy and that is that
pregnancy is a hyper is a hyper hyper
coagula bull Berko available
hypercoagulable state so that is to say
that the clotting mechanisms in blood
are running an overdrive during
pregnancy so blood clots really easily
and this is primarily because in
pregnancy there's an increase in the
production of clotting factors so
factors such as thrombin and fibrin
engine and other clotting factors are
made more and there's there's a lot of
thought that perhaps this occurs to
protect the mother from excessive
bleeding during delivery especially the
bleeding that occurs when the placenta
separates from the uterus so so maybe
this is all meant to be protected the
problem is is that sometimes you can
have too much of a good thing and you
end up with blood clots most commonly in
the deep veins of the legs and some of
that some of that actually has to do
with the fact that the enlarging uterus
puts pressure on the inferior vena cava
and the veins of the legs and that
causes blood to pool in the lower
extremities which is actually why
pregnant ladies also always complain of
swollen legs anyways this pooling of
blood in the legs can lead to blood clot
and those blood clots are called deep
vein they're called deep vein deep vein
thrombosis deep vein thrombosis Iram
BOCES just means clot so in fact
the risk of having a deep vein
thrombosis is increased by five fold and
pregnancy and it's important to know
because the clot in the legs can break
off and it can travel to the lungs
leading to a pulmonary embolus in up to
40 percent of cases in which you have a
DVT which is dangerous and potentially
fatal to the mom so when the presence of
a DVT or any any clot or thromboembolism
of that for that matter is confirmed the
woman is put on anticoagulant therapy
right away so those are just a couple of
the very important changes that occur in
the blood system of a pregnant woman