Increased hemoglobin in pregnancy: why do something?
Elevated hemoglobin in pregnancy is a pathology that occurs in women prone to blood clotting problems, which requires timely diagnosis and treatment to prevent the development of complications in childbirth. This problem is not as frequent as low hemoglobin, but it is no less important and also requires the attention of a doctor. The development of symptoms can be latent, so you need to know the first signs and symptoms of this pathology.
Epidemiology
The epidemiology of this pathology is such that about 5% of women have this pathology in the third trimester of pregnancy, and in 85% of women it is asymptomatic. Only 10% of cases require treatment or any measures. Prevalence is higher in those women who have a predisposition to blood circulation disorders.
Causes of the increased hemoglobin during pregnancy
To know the main causes of increased hemoglobin in pregnancy and understand the mechanisms of the pathogenesis of this problem, you need to know the normal properties of hemoglobin, erythrocytes and their ratio, respectively, the function. Hemoglobin is the main component of erythrocytes - red blood cells. Erythrocytes provide the transfer of the oxygen molecule from the lungs to all cells of the female body precisely due to the content of hemoglobin in its composition. The hemoglobin molecule itself contains a globin protein on which the heme is configured - it is a complex prostacyclic compound that contains in the center an iron molecule. It is the trace element of trivalent iron that attaches an oxygen molecule, and then gives it to the cell during oxidation. Such a complex structure of hemoglobin and provides its main function in the transfer of oxygen and maintenance of cellular respiration. Therefore, an increase in the amount of hemoglobin in pregnant women can be correlated, as an increase in the elemental elements in a unit of the liquid part of the blood. This condition can cause serious violations in the health of both the mother and the child precisely because of the thickening of the blood.
Thus, an increase in the hemoglobin level can be caused by a decrease in the amount of liquid part of the blood or an increase in the formed elements.
The reasons for this state can be many. Reducing the level of blood plasma can be due to the body's excoxicosis after acute conditions. Such conditions include acute blood loss, diarrhea or vomiting, burns with significant exci- cosis. These conditions are characterized by loss of blood or plasma, or liquid, which is respectively accompanied by an increase in hematocrit, and therefore increases the level of hemoglobin. Such a cause of increased hemoglobin in pregnant women is not often, because these are serious conditions that threaten the life of a woman.
Also, the cause of increased hemoglobin during pregnancy can be compensatory reaction of the body to fetal development and the nearest childbirth. This is due to the fact that the body of a pregnant woman has an additional circulatory system, which also needs an increased amount of oxygen. At the same time, the number of erythrocytes increases and hemoglobin also increases. Such a physiological process of increasing the number of uniform elements ensures normal functioning of the fetal circulation. If the increase in hemoglobin level occurs for this reason, it does not cause any symptoms and do not worry about it. With this physiological process, the increase is no more than 10% of the normal values. But there are cases when an increase in hemoglobin in pregnant women requires immediate action, since there is a risk of complications. This, as a rule, occurs with an increase in hemoglobin above 160 g / l.
Risk factors
Risk factors for complications due to elevated hemoglobin level are in those women who have a history of history of data on vascular weakness or bleeding disorders. There are women who are especially prone to thrombosis precisely because of a violation of the tone of the venous wall and a tendency to increased coagulation. In these women, an increase in hemoglobin during pregnancy can cause a pronounced varicose veins and thrombosis of various locations, which will characterize the features of the clinic. Therefore, women from the risk group should carefully monitor these indicators.
Symptoms of the increased hemoglobin during pregnancy
The increase in hemoglobin can not be felt at all and is simply a sign that is determined by the next examination for blood test data. But sometimes, when the pathology develops against the background of a clotting disorder, characteristic clinical signs appear.
The first signs of an increase in hemoglobin during pregnancy can be manifested for the first time only in the third trimester of pregnancy, when the body prepares for future childbirth and reserves the necessary resources with allowance for possible blood loss. This increases the number of erythrocytes, hemoglobin, and increases the procoagulant properties of the blood. Such changes can be accompanied by subjective symptoms in the form of dizziness due to disruption of normal blood circulation in the brain, as well as violations of peripheral circulation. This also occurs because of the reduced ability of the blood to pass through the small capillaries due to the propensity to form blood clots. This will be manifested by cold limbs and chill fingers. Later secondary disorders develop, are caused by a worsening of the blood supply of nerve fibers - this is manifested by paresthesias and cramps in the muscles of the hands.
There may be other nonspecific symptoms in the form of increased fatigue, headache, tremor of the extremities, deterioration of appetite, sleep disturbance as drowsiness. Due to a violation of blood circulation, there may be a deterioration in vision.
Often, the increase in hemoglobin is only recognized if there are symptoms of varicose veins of the lower limbs, especially in the late term. This is due to the fact that women who are prone to this pathology are losing the tone of the veins, and increasing hemoglobin levels aggravates these changes and develops a serious disease with stagnation of blood. Such dilated veins can bleed and this has bad consequences in the absence of treatment. Therefore, if a woman has a varicose disease, even in a state of compensation, it is necessary to control the level of hemoglobin, since these concepts are interrelated.
Diagnostics of the increased hemoglobin during pregnancy
Diagnosis of elevated hemoglobin is more often accidental, since the pathology is asymptomatic. But you should pay attention to the patient's complaints, and if they concern the deterioration of the general condition or headache, then it is necessary to conduct a general blood test to exclude anemia or in this case increase hemoglobin, which may have similar clinical signs.
You need to carefully examine the woman and pay attention to the condition of the veins of the lower extremities. If there is their tortuosity or superficial location, then a laboratory test should be conducted to prevent the development of major changes.
Analyzes that are conducted in this pathology, and is the most informative - this is a general blood test, and also to monitor coagulation of the blood, a coagulogram should be performed. In the general blood test, erythrocytes with hemoglobin, platelets, leukocytes, and ESR are determined. Normal blood hemoglobin for women is 120-140 g / l, and for men - 130-160 g / l. If the decrease in the increase in hemoglobin in pregnant women is less than 10%, then it is a physiological thickening of the blood, but if this figure is more than 160 g / l, then you should pay attention to this change.
It is also necessary to conduct a general analysis of urine to exclude kidney damage, because they can also suffer with circulatory disorders, ischemia of the glomerular apparatus, and impaired function.
Instrumental diagnostics can be used when there is a thickening of the blood and it is necessary to find out the degree of circulatory disturbance in the heart, as well as peripheral vessels - veins. For this, an ultrasound duplex study is performed to determine the blood flow velocity in the main organs. With an increase in hemoglobin, this indicator will be higher than the normative values. In order to study the function of veins against the background of this pathology, to study the prognosis of thrombosis and varicose veins, phlebography is performed. This is a method of research, in which contrast is introduced into the veins and their fullness filled with contrast, sizes, areas of expansion and tone.
Differential diagnosis
Differential diagnosis of elevated hemoglobin during pregnancy should be conducted with acute conditions that can accompany this condition. Therefore, it is necessary to exclude from the woman chronic latent hemorrhage, as well as other states of dehydration. For this, first of all, it is necessary to determine the cause of the pathology and, if necessary, to perform fibrogastroscopy or ultrasound examination of the abdominal wall organs.
Treatment of the increased hemoglobin during pregnancy
Treatment of this pathology at physiological levels of increase in indices is not required. The possibility of treating elevated hemoglobin during pregnancy is considered only when there are pronounced clinical symptoms associated with this and there is a concomitant pathology.
In any case, you need to start with dietary recommendations. It is necessary to use a sufficient amount of water so that the rheological properties of the blood do not deteriorate. It is also necessary to replace the red grades of meat in the diet with white, which will reduce the exogenous sources for the synthesis of hemoglobin. You also need to adhere to the diet, which will help to normalize overall health.
Drug therapy can be indicated with a significant increase in the hematocrit, then you can perform an infusion therapy to restore the volume of circulating blood. To do this, use glucose-salt solutions in a ratio of one to one. Infusion can be carried out in a short-term mode, then during three days it is possible to restore the normal state of the indicators.
Specific drugs to reduce hemoglobin levels do not exist, and in any case it is not advisable to use. Therefore, when a clinical picture of elevated hemoglobin appears during pregnancy, the treatment is symptomatic. The use of nonfractional heparin or low molecular weight heparins is not justified because they are contraindicated in pregnancy. Use drugs that improve the rheological properties of blood and promote the normalization of peripheral circulation without serious interventions in the blood coagulation system.
- Spasmolytic agents help to improve not only the peripheral circulation, but also improve the circulation of internal organs, preventing the development of their ischemia, and the blood circulation of the fetus. They do not have side effects on the fetus and therefore can be used as symptomatic therapy.
Papaverine hydrochloride is a myotropic antispasmodic which, upon admission to the cell, blocks the synthesis of cyclic adenosine monophosphate, due to which it acts not only on the smooth muscles of the internal organs, but also on the peripheral vessels, which causes their relaxation. It has a pronounced effect primarily on the arteries, which causes an improvement in blood circulation with increased hemoglobin and blood clots with a decrease in the severity of clinical symptoms. The use of papaverine in this case is in a tablet form, which will help to have a longer and more pronounced effect. Dosage - 10 milligrams 2 times a day for three to five days. Side effects of papaverine during pregnancy are possible in the form of allergic manifestations with skin rash, nausea and vomiting, disorders of stool with constipation, abdominal pain. There may also be symptoms from the cardiovascular system in the form of conduction disturbances right up to the blockade, extrasystole, arterial hypotension. Possible increased sweating and drowsiness, as well as a transient asymptomatic increase in the level of hepatic enzymes.
Precautions - with caution should be used with concomitant hypotension.
- Pentoxifylin is a drug from the group of peripheral vasodilators that can be used with elevated hemoglobin as a means for eliminating the symptoms of ischemia, both peripheral and internal ischemia. The way of using the drug is a pill that you need to wash down with water without chewing. Dosage of the drug - two tablets three times a day. Side effects are possible in the form of tachycardia, arrhythmia, sensation of heat, headache, pancytopenia, paresthesia. Precautions - with a tendency to bleeding or a peptic ulcer with bleeding in an anamnesis, the drug should not be used.
The use of other medicines to treat elevated hemoglobin during pregnancy is not justified, since other drugs can harm a child or mother, or lead to complicated childbirth. Therefore, the choice should be made between these symptomatic means.
Vitamins can be used to maintain the overall immune status of women and normalize the deficiency of trace elements. Can use complex vitamin preparations with ascorbic acid, which improves the permeability of the vascular cell and prevents possible complications associated with elevated hemoglobin. It is necessary to exclude the intake of iron with such a vitamin therapy.
Operative treatment of this pathology is not used. There may be indications for prompt intervention if the cause of increased hemoglobin is blood loss, which is characterized by an acute condition requiring surgery in urgent order.
Alternative treatment of elevated hemoglobin in pregnancy
Alternative treatment of elevated hemoglobin is a priority because of the fact that drug therapy in this case can harm a child. Therefore, many alternative methods are used that help to normalize not only the rheological properties of blood, but also the state of the arterial and venous vascular wall. The main alternative methods are as follows:
- Ginger with cinnamon has very good properties of penetration into the vascular bed and normalization of the hemoglobin level and shaped elements, and also has excellent detoxification and antioxidant properties. To prepare a medicinal solution, you need to add half a teaspoon of cinnamon and twenty grams of ginger cut into pieces to a liter of boiled water. Such tea should be drunk during the day at least one and a half liters per day, in the case if there is no edema during pregnancy.
- Wheat germ also well dilutes blood. Before use, it is recommended to thoroughly wash the wheat and pour a small amount of water. Such wheat should be eaten raw in a few grains per day, by adding to salads.
- The horse-radish root also has the properties to improve the rheological properties of the blood and can be used as an antithrombotic agent, especially when prone to varicose veins. With a curative purpose, one simply needs to use it every day in food in small amounts throughout the week.
Herbs also have many beneficial properties in relation to the circulatory system, and they can normalize pressure, relieve headache and improve peripheral circulation by flooding the body.
- Very useful properties for reducing the level of hemoglobin has tea from currant, viburnum and dogrose. For such tea per liter of water, you need to take 50 grams of each fruit and make compote, which should be drunk throughout the day in sufficient quantities.
- Tincture of the skin of a young chestnut is also widely used to treat this condition, but during pregnancy alcoholic tincture should be replaced with water. To do this, 300 grams of water should be taken from the skin of three chestnuts, pour boiling water and insist for three days, then take a tablespoon in the morning and evening.
- Leaves of lemon balm and yellow burkuna should be poured with boiling water and drunk in a warm form for half a cup in the morning on an empty stomach for five days.
Homeopathic remedies can also be used, since they can be used for a long time without harm to the child and very highly effective.
- Mercurius is a homeopathic remedy based on inorganic material. Used to treat blood circulation pathologies with severe headaches. Method of application - under the tongue, dosage - ten drops of solution three times a day. Adverse events occur rarely, allergic manifestations are possible.
- Viper berus is a preparation from snake venom, which has antithrombotic properties. Dosage and the way of application of the preparation - seven granules three times a day, keep in the mouth until complete resorption. Side effects are possible in the idea of a cough that has a dry character. Precautions - patients with a history of allergic anamnesis should be used with caution.
- Apis melifika is a preparation based on the honey bee extract, which is used for the expressed swelling of the face, legs, and also accompanying thrombophlebitis against the background of increased hemoglobin. Dosage of the drug - seven granules three times a day. Method of application - you need to dissolve the granules until they are completely dissolved. Side effects are possible in the form of allergies in patients with bronchial asthma. Precautions - do not apply to any allergic reactions to honey.
- Eskulius is a horse chestnut preparation that has tropism to the uterus, which is why it is used for circulatory disorders in the pelvic area and symptoms of ischemia. The drug is available in the form of drops. Method of application and dosage - ten drops per glass of warm water. Side effects are rare, dyspeptic disorders are possible.
These alternative and homeopathic remedies can be used for a long time before the period of labor, if there are no complications and there is a positive dynamics in the symptoms.
Prevention
The main complications that may be due to increased hemoglobin are associated with a violation of the rheological properties of the blood and a violation of the peripheral blood circulation, including the fetus. There may be consequences in the form of chronic fetal hypoxia, a violation of utero-placental circulation, premature aging of the placenta. It can also contribute to the ischemia of the vital organs of a woman - renal blood flow is disturbed, kidney hypertension develops with further risk of pre-eclampsia. But all these changes can develop only with prolonged and malignant increase in the level of hemoglobin and blood thickening.
Prevention of hemoglobin increase is in nonspecific measures. First of all, a pregnant woman should carefully monitor her diet and drinking regimen to avoid dehydration. It is necessary to conduct all the mandatory methods of research in pregnancy in time to identify any pathologies that may be a consequence of this pathology.
Forecast
The prognosis for normal gestation with increasing hemoglobin levels within physiological values is positive when the volume of circulating blood is restored and the complications are prevented.
Increased hemoglobin in pregnancy - the problem is not frequent, the cause of which in most cases is the physiological processes of the preparation of the woman's organism for childbirth. Therefore, the use of treatment in this case with medication is not recommended in the absence of severe clinical symptoms. Treatment should mainly be performed against the background of normalization of rehydration and through the use of alternative means.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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