Summary
Samenvatting - Blok 5 - Bloed en Infecties
- Course
- Institution
Volledige samenvatting van Blok 5 (inclusief EBM)
[Show more]
2 reviews
By: JGotink • 1 week ago
By: lynnfranssen2001 • 2 days ago
Seller
Follow
liannegiovinazzo
Reviews received
Content preview
,Table of ContentsLaboratorium onderzoek ................................................................................................................................................................................................................................ 7
Bloedonderzoek .............................................................................................................................................................................................................................................................................. 7
Intakelab – PSIE programma ........................................................................................................................................................................................................................................................... 7
Bloedgroepen & Antistoffen ........................................................................................................................................................................................................................... 8
Bloedgroepen .................................................................................................................................................................................................................................................................................. 8
Erytrocytenantistoffen .................................................................................................................................................................................................................................................................... 9
Bloedcontact ................................................................................................................................................................................................................................................................................. 11
IEA – Screening & Diagnostiek....................................................................................................................................................................................................................................................... 12
Hemolytische ziekte van de foetus en pasgebore (HZFP) / Erythroblastosis Foetalis ................................................................................................................................................................... 13
Preventie anti-D Immunisatie ....................................................................................................................................................................................................................................................... 16
Hematologische Aandoeningen - Bloedarmoede .......................................................................................................................................................................................... 18
Fysiologie – Levensloop van de Erytrocyt en de IJzerkringloop .................................................................................................................................................................................................... 18
Fysiologie – Hemoglobine & Globineketens.................................................................................................................................................................................................................................. 19
Bloedonderzoek – Definities & (Normaal)waardes ....................................................................................................................................................................................................................... 20
Anemie (in de zwangerschap) ....................................................................................................................................................................................................................................................... 21
Etiologie Anemie – Ijzergebreksanemie ........................................................................................................................................................................................................................................ 25
Etiologie Anemie – Vitamine B12 deficiëntie ................................................................................................................................................................................................................................ 26
Etiologie Anemie – Foliumzuur deficiëntie.................................................................................................................................................................................................................................... 27
Etiologie Anemie – G6PD deficiëntie ............................................................................................................................................................................................................................................. 29
Hemoglobinopathieën – Sikkelcelziekte ....................................................................................................................................................................................................................................... 29
Hemoglobinopathieën – 𝜶-thalassemie ........................................................................................................................................................................................................................................ 32
Hemoglobinopathieën – 𝜷-thalassemie ........................................................................................................................................................................................................................................ 35
Hematologische Aandoeningen - Stollingsstoornissen .................................................................................................................................................................................. 37
Bloedstolling – Fysiologie .............................................................................................................................................................................................................................................................. 37
Bloedstolling – Fysiologie in de zwangerschap ............................................................................................................................................................................................................................. 38
Bloedstolling – Pathofysiologie ..................................................................................................................................................................................................................................................... 39
, Verhoogde bloedingsneiging - Hemofilie A & B ............................................................................................................................................................................................................................ 40
Verhoogde bloedingsneiging - Ziekte van Von Willebrand ........................................................................................................................................................................................................... 42
Verhoogde tromboseneiging (trombofilie) - Proteïne C of S deficiëntie ....................................................................................................................................................................................... 43
Verhoogde tromboseneiging (trombofilie) - Factor V Leiden / APC resistentie ............................................................................................................................................................................ 45
Tromboflebitis ............................................................................................................................................................................................................................................................................... 45
Veneuze Trombose........................................................................................................................................................................................................................................................................ 46
Veneuze Trombose – Zwangerschap & Kraambed........................................................................................................................................................................................................................ 50
Diffuse Intravasale Stolling (DIS) ................................................................................................................................................................................................................................................... 52
Maternale Trombocytopenie ........................................................................................................................................................................................................................................................ 53
Idiopatische (auto-immuun) Trombocytopenische Purpura / Immuun Trombocytopenie (ITP) .................................................................................................................................................. 56
Foetale en Neonatale Allo-Immuun Trombocytopenie (FNAIT) .................................................................................................................................................................................................... 58
Hypertensieve Aandoeningen ...................................................................................................................................................................................................................... 60
Fysiologie – Hemodynamische veranderingen .............................................................................................................................................................................................................................. 60
Hypertensie in de Zwangerschap .................................................................................................................................................................................................................................................. 61
Hypertensie in de Zwangerschap – Etiologische factoren............................................................................................................................................................................................................. 62
Zwangerschapshypertensie / Pregnancy Induced Hypertension (PIH) ......................................................................................................................................................................................... 64
Pre-Eclampsie ................................................................................................................................................................................................................................................................................ 65
HELLP-Syndroom ........................................................................................................................................................................................................................................................................... 70
Eclampsie....................................................................................................................................................................................................................................................................................... 71
Chronische / Pre-existente Hypertensie........................................................................................................................................................................................................................................ 72
Menstruatiestoornissen ............................................................................................................................................................................................................................... 73
Cyclusstoornissen (Begrippen) ...................................................................................................................................................................................................................................................... 73
Cyclusstoornissen – Amenorroe .................................................................................................................................................................................................................................................... 74
Amenorroe – Syndroom van Asherman ........................................................................................................................................................................................................................................ 76
Amenorroe – Polycysteus-ovariumsyndroom (PCOS) ................................................................................................................................................................................................................... 77
Amenorroe – Syndroom van Sheehan .......................................................................................................................................................................................................................................... 79
Cyclusstoornissen – Dysmenorroe ................................................................................................................................................................................................................................................ 80
Dysmenorroe – Endometriose ...................................................................................................................................................................................................................................................... 81
, Dysmenorroe – Uterus Myomen & Fibromen ............................................................................................................................................................................................................................... 83
Bloedverlies – < 16 weken AD ....................................................................................................................................................................................................................... 84
Vaginaal Bloedverlies – 1ste trimester............................................................................................................................................................................................................................................ 84
Gynaecologische oorzaken – Ectropion van de cervix (contactbloeding) ..................................................................................................................................................................................... 87
Obstetrische Oorzaken – Abortus (miskraam) .............................................................................................................................................................................................................................. 88
Obstetrische Oorzaken – Ectopische Graviditeit (extra-uteriene graviditeit, EUG) ...................................................................................................................................................................... 92
Obstetrische Oorzaken – Mola Hydatidosa (mola zwangerschap) ................................................................................................................................................................................................ 95
Bloedverlies - > 16 weken AD ....................................................................................................................................................................................................................... 97
Vaginaal bloedverlies – 2de / 3de trimester .................................................................................................................................................................................................................................... 97
Placenta Praevia ............................................................................................................................................................................................................................................................................ 98
Abruptio / Solutio Placentae ....................................................................................................................................................................................................................................................... 100
Vasa Praevia ................................................................................................................................................................................................................................................................................ 103
Bloedverlies – Durante / Post Partum......................................................................................................................................................................................................... 104
Placenta Accreta Spectrum (PAS) ................................................................................................................................................................................................................................................ 104
Uterusruptuur ............................................................................................................................................................................................................................................................................. 106
Inversio Uteri ............................................................................................................................................................................................................................................................................... 108
Retentio Placentae ...................................................................................................................................................................................................................................................................... 109
Heamorhagia Post Partum / Fluxus Post Partum ........................................................................................................................................................................................................................ 110
Bloedverlies – Het Kraambed ..................................................................................................................................................................................................................... 116
Vaginaal bloedverlies – Het Kraambed ....................................................................................................................................................................................................................................... 116
Vulvovaginale bloedingen ........................................................................................................................................................................................................................................................... 116
Placenta rest ................................................................................................................................................................................................................................................................................ 117
Shock ......................................................................................................................................................................................................................................................... 118
Shock ........................................................................................................................................................................................................................................................................................... 118
Hypovolemische Shock ................................................................................................................................................................................................................................................................ 119
(Acute) Buikpijn ......................................................................................................................................................................................................................................... 121
, (Acute) Buikpijn in de zwangerschap .......................................................................................................................................................................................................................................... 121
Appendicitis ................................................................................................................................................................................................................................................................................. 122
Cystitis ......................................................................................................................................................................................................................................................................................... 124
Pyelitis / Pyelonefritis .................................................................................................................................................................................................................................................................. 127
Parametritis ................................................................................................................................................................................................................................................................................. 128
Endometritis ................................................................................................................................................................................................................................................................................ 129
Salpingitis .................................................................................................................................................................................................................................................................................... 130
Pelveoperitonitis / PID ................................................................................................................................................................................................................................................................ 131
Cholelithiasis ............................................................................................................................................................................................................................................................................... 131
Cholecystitis ................................................................................................................................................................................................................................................................................ 133
Gastro-enteritis / Buikgriep ......................................................................................................................................................................................................................................................... 134
Koorts in het kraambed .............................................................................................................................................................................................................................. 135
Koorts Post Partum ..................................................................................................................................................................................................................................................................... 135
Kraamvrouwenkoorts / Puerperale sepsis .................................................................................................................................................................................................................................. 136
(Perineum) wond infectie ............................................................................................................................................................................................................................................................ 137
Mastitis ........................................................................................................................................................................................................................................................................................ 137
De Ongewenste Zwangerschap .................................................................................................................................................................................................................. 139
Abortus – Incidentie .................................................................................................................................................................................................................................................................... 139
Abortus – Behandelingen ............................................................................................................................................................................................................................................................ 139
Abortus – Wet- en Regelgeving ................................................................................................................................................................................................................................................... 142
Abortus – Begeleiding ................................................................................................................................................................................................................................................................. 145
Adoptie ........................................................................................................................................................................................................................................................................................ 146
Draagmoederschap ..................................................................................................................................................................................................................................................................... 149
Ei- / Zaadcel Donatie ................................................................................................................................................................................................................................................................... 150
Maternale Sterfte ...................................................................................................................................................................................................................................... 151
Maternale Sterfte – Begrippen.................................................................................................................................................................................................................................................... 151
Maternale Sterfte – Etiologie ...................................................................................................................................................................................................................................................... 151
Maternale Sterfte – Epidemiologie ............................................................................................................................................................................................................................................. 153
, Maternale Sterfte – Preventie Plan ............................................................................................................................................................................................................................................. 154
(On)gelijkheid .............................................................................................................................................................................................................................................................................. 156
De Verloskundige Zorg ............................................................................................................................................................................................................................... 156
Kwaliteit Bewaken ....................................................................................................................................................................................................................................................................... 156
Kwaliteit Beoordelen & Bevorderen – Methodisch Intercollegiaal Overleg................................................................................................................................................................................ 158
Klachten – Tuchtrecht ................................................................................................................................................................................................................................................................. 161
Mondelinge Competentie Toets – Infectieziekten ....................................................................................................................................................................................... 163
Infectieziekten (per OWG)........................................................................................................................................................................................................................................................... 163
Evidence Based Midwifery ......................................................................................................................................................................................................................... 165
Basisdomeinen Epidemiologie .................................................................................................................................................................................................................................................... 165
Interventie onderzoek – Uitkomsten .......................................................................................................................................................................................................................................... 165
Interventie onderzoek – Uitkomsten interpreteren.................................................................................................................................................................................................................... 166
Interventie onderzoek – Kwaliteit beoordelen ........................................................................................................................................................................................................................... 167
Checklist – RCT Beoordeling ........................................................................................................................................................................................................................................................ 169
, Laboratorium onderzoek Bloedonderzoek
Indicaties redenen voor het aanvragen van een (x)-lab:
- ziektescreening
- bevestiging van een klinische verdenking naar aanleiding van de klachten van een patiënt
- het uitsluiten van een diagnose
- ondersteuning bij de behandeling en prognose van een ziektebeeld
- monitoring van de ernst en het beloop van een ziekte
Zwangerschap standaard / meest voorkomende bloedonderzoeken in de zwangerschap:
- intakelab → Hb, glucose (op indicatie), schildklierfunctie (op indicatie), bloedgroep, IEA, HIV, Hep-B, Lues
- NIPT (op verzoek) → chromosoom 21, 18 en 12 (+ evt. nevenbevindingen)
- 20-weken Hb-controle bij risicogroepen voor anemie
- 24-28 weken OGTT bij risicogroepen voor diabetes gravidarum
- 27 weken bepalen foetRh(D) en IEA bij Rh(D)neg moeders
- 27 weken bepalen IEA bij Rh(c)neg moeders
- 30 weken Hb-controle
- op indicatie
labgegevens interpreteren in de zwangerschap:
- let op de eenheden van de uitslagen
- referentiewaardes kunnen verschillen in de zwangerschap (bijv. het geval bij Hb-waarde en EKR)
- overleg met klinisch chemicus of medisch microbioloog (infecties) is altijd mogelijk → niet zelf gokken als je het niet zeker weet
Intakelab – Prenatale Screening Infectieziekten en Erytrocytenimmunisatie (PSIE) programma
Doel = hepatitis B- en hiv-dragerschap, congenitale syfilis en hemolytische ziekte van de foetus en/of de pasgeborene voorkomen
TIJDLIJN procedures PSIE-programma
8 Procesmonitor PSIE 2017
uitvoering bloedonderzoek zwangeren
zwangerschapsduur (weken)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 .....................................................................
bevalling 42
1e consult
Acties: bij voorkeur vóór WEEK 13 mogelijke VERVOLGACTIES WEEK 27 WEEK 30 POSTPARTUM POSTNATAAL
Erytrocytenimmunisatie:
Irregulaire erytrocytenantistoffen (IEA) - IEA aangetoond?
- volg advies Sanquin en/of BIBO
Was IEA al bekend? Meld aan RIVM-DVP
Rhesus c-antigeen - Rhesus c-negatief? IEA aangetoond?
extra onderzoek op IEA - - volg advies Sanquin
Rhesus D-antigeen - Rhesus D-negatief? IEA aangetoond?
extra onderzoek op IEA - - volg advies Sanquin
foetale RhD-typering - Kind RhD-positief? Kind RhD-pos?
- moeder anti-D toedienen - moeder nogmaals
anti-D toedienen
Infectieziekten:
Syfilis - Syfilis positief? - bloedonderzoek - bloedonderzoek
- overleg en/of verwijs moeder kind
- informeer huisarts
Was infectie al bekend? Meld aan RIVM-DVP
HIV - HIV-positief?
- verwijs naar HIV-behandelcentrum
- informeer huisarts
Was infectie al bekend? Meld aan RIVM-DVP
HepB - HepB-positief? - HBlg
- meld bij GGD - HB-vaccin
- folder en recept HBIg (zwangere)
- overleg en/of verwijs (bij HBeAg-positief)
- informeer huisarts
Was infectie al bekend? Meld aan RIVM-DVP
Bron: RIVM
,Bloedgroepen & Antistoffen
Bloedgroepen
B.g. bepaling de aan- of afwezigheid van specifieke oppervlakte antigenen op het plasmamembraan van de erytrocyt bepalen de bloedgroep
genetisch bepaald:
- volledig codominant → beide allelen van de bloedgroep (één van iedere ouder) komen tot expressie op het celmembraan
tegen de oppervlakte antigenen kunnen antistoffen gevormd worden
- onderverdeeld in regulaire en irregulaire erytrocytenantistoffen
- notatie: anti-(naam/letter antigeen)
B.g. antagonisme wanneer er sprake is van contact tussen 2 soorten bloed die verschillen in bloedgroep / aanwezige antigenen en antistoffen
dit kan een transfusiereactie tot gevolg hebben:
- de antistoffen van de donor reageren op de antigenen van ontvanger
- de antistoffen stimuleren agglutinatie waardoor bloedpropjes zich in de bloedbaan vormen
(deze bloedpropjes kunnen de perifere vaten blokkeren waardoor weefselschade en afsterving ervan kan optreden)
- hemolyse vindt plaats van de samengeklonterde erytrocyten → leidt tot anemie
(klachten als gevolg van orgaanschade zijn meestal eerder en ernstiger aanwezig)
Sensibilisatie erytrocytenimmunisatie = de aanwezigheid van antistoffen in het bloed tegen niet-lichaamseigen erytrocyten
- de sensibilisatie (afweerreactie) is afhankelijk van de immunogeniciteit van de antistoffen
= het vermogen van het bloedgroepantigeen om de antistofrespons (de aanmaak van de antistoffen) te stimuleren / op te wekken
- (naast problematiek in de zwangerschap) belangrijk om immunisatie te voorkomen: hoe meer verschillende antistoffen het bloed bevat, des te
moeilijker is het om compatibel bloed te vinden in gevallen dat bloedtransfusies etc. noodzakelijk zijn
→ naast AB0 en RhD, ook K-, Rhc- en RhE-compatibel bloed geven bij bloedtransfusies voor vrouwen jonger dan 45 jaar
, erytrocytenimmunisatie in de zwangerschap:
1ste bloedcontact → moeder vormt antistoffen tegen antigenen op de erytrocyt van de foetus/pasgeborene (verder geen gevolgen)
de
2 zwangerschap → antistoffen in maternale bloed passeren de placenta en starten afweerreactie tegen het foetale bloed
Erytrocytenantistoffen
Regulaire EA = de antistoffen van het “gewone” bloedgroepensysteem; het AB0-systeem
- de aan- of afwezigheid van deze antigenen en antistoffen is genetisch bepaald
→ geen bloedcontact is nodig voor de vorming van deze antistoffen (deze zijn standaard aan- of afwezig)
- voornamelijk IgM-klasse antistoffen (kunnen ook als antistoffen van de IgG-klasse voorkomen)
Irregulaire EA = de antistoffen van ieder ander (zeldzamer) bloedgroepensysteem
- de aan- of afwezigheid van een antigeen is genetisch bepaald, indien geen antigeen aanwezig is kunnen antistoffen ertegen gevormd worden
→ bloedcontact is nodig voor de vorming van deze antistoffen (deze zijn niet standaard aanwezig)
- voornamelijk IgG-klasse antistoffen
- er zijn > 300 erytrocytenbloedgroepen bekend, de meeste erytrocyten hebben minstens 50 verschillende oppervlakteantigenen
de meest voorkomende IEA zijn:
• Rhesus - bloedgroepensysteem → anti-D, anti-C/c, anti-E/e
• Kell - bloedgroepensysteem → anti-K
• Duffy - bloedgroepensysteem → anti-Fy(a)/(b)
• Kidd - bloedgroepensysteem → anti-Jk(a)/(b)
• MNSs - bloedgroepensysteem → anti-S/s
• Irregulaire IgG-klasse anti-A en/of anti-B
(deze zijn het meest klinisch relevant doordat deze HZFP kunnen veroorzaken, alle andere IEA zijn alleen van belang bij bloedtransfusies etc.)
, Verschillen rhesus immunisatie vs. bloedgroep immunisatie
Notatie EA AB0-systeem → A(0) – B(0) – AB – 0(0)
IEA systemen → positief + = 𝑥 antigeen aanwezig
negatief - = 𝑥 antigeen niet aanwezig, IEA ertegen zouden aanwezig kunnen zijn / gevormd worden
- hoofdletter en kleine letter aanwezig in bloedgroepensysteem:
• CC = c negatief
• Cc = c positief
• cc = c positief
- alleen hoofdletter aanwezig in bloedgroepensysteem: kleine letter wordt gebruikt als “niet aanwezig”
• Dd = rhesus D positief
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller liannegiovinazzo. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $19.52. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
72042 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now