Increased hemoglobin in pregnancy: why and what to do?

Increased hemoglobin during pregnancy is a pathology that occurs in women prone to blood clotting problems, which requires timely diagnosis and treatment to prevent complications during childbirth. This problem is not as common as low hemoglobin, but it is no less important and also requires the doctor's attention. The development of symptoms can be latent, so you need to know the first signs and symptoms of this pathology.

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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. The prevalence is higher in those women who have a predisposition to circulatory disorders.

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Causes elevated hemoglobin during pregnancy

In order to know the main reasons for the increase in hemoglobin during pregnancy and to understand the mechanisms of pathogenesis of this problem, it is necessary to know the normal properties of hemoglobin, erythrocytes and their ratio according to the function. Hemoglobin is the main component of erythrocytes - red blood cells. Erythrocytes provide the transfer of an oxygen molecule from the lungs to all cells of the female body precisely due to the content of hemoglobin in their composition. The hemoglobin molecule itself contains the protein globin, on which heme is configured - this is a complex prostacyclic compound, which contains an iron molecule in the center. It is the microelement of trivalent iron that attaches an oxygen molecule, and then, when oxidized, gives it to the cell. Such a complex structure of hemoglobin ensures its main function in the transfer of oxygen and maintaining cellular respiration. Therefore, an increase in the amount of hemoglobin in pregnant women can be correlated as an increase in formed elements in a unit of the liquid part of the blood. This condition can cause serious health problems for both the mother and the child precisely due to blood thickening.

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 formed elements.

There may be many reasons for this condition. A decrease in the blood plasma level may be due to exicosis of the woman's body after acute conditions. Such conditions include acute blood loss, diarrhea or vomiting, burns with significant exicosis. These conditions are characterized by the loss of blood or plasma, or fluid, which is accordingly accompanied by an increase in hematocrit, therefore the hemoglobin level increases. This cause of increased hemoglobin in pregnant women is not common, since these are serious conditions that threaten the life of a woman.

Also, the cause of increased hemoglobin during pregnancy may be the body's compensatory reaction to fetal development and the upcoming birth. This develops due to the fact that the pregnant woman's body has an additional circle of blood circulation, which also needs an increased amount of oxygen. In this case, the number of red blood cells increases and hemoglobin also increases. Such a physiological process of increasing the number of formed elements ensures the normal functioning of the fetal circulation. If the increase in hemoglobin levels occurs for this reason, then this does not cause any symptoms and you should not worry about it. With such a physiological process, the increase occurs by no more than 10% of normal values. But there are cases when an increase in hemoglobin levels in pregnant women requires immediate action, since there is a risk of complications. This usually occurs when hemoglobin increases above 160 g / l.

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Risk factors

Risk factors for complications due to elevated hemoglobin levels are present in women with a family history of vascular weakness or blood clotting disorders. There are women who are particularly prone to thrombosis due to impaired venous wall tone and a tendency to increased clotting. In these women, elevated hemoglobin levels during pregnancy can cause severe varicose veins and thrombus formation in various locations, which will characterize the clinical features. Therefore, women at risk should especially carefully monitor these indicators.

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Pathogenesis

The pathogenesis of the development of clinical symptoms depends on the cause, so it is important to conduct a thorough diagnosis to determine the etiological factor before treatment.

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Symptoms elevated hemoglobin during pregnancy

An increase in hemoglobin may not be felt in any way and be just a sign that is determined during a routine examination using blood test data. But sometimes, when pathology develops against the background of a blood clotting disorder, characteristic clinical signs appear.

The first signs of increased hemoglobin during pregnancy may appear for the first time only in the third trimester of pregnancy, when the body prepares for future birth and stores the necessary resources, taking into account possible blood loss. At the same time, the number of red blood cells, hemoglobin increases, and the procoagulant properties of the blood also increase. Such changes may be accompanied by subjective symptoms in the form of dizziness due to disruption of normal blood circulation in the brain, as well as disruption of peripheral circulation. This also occurs due to the reduced ability of blood to pass through small capillaries due to the tendency to form blood clots. This will manifest itself in cold extremities and chilly fingers. Later, secondary disorders develop, caused by deterioration of the blood supply to nerve fibers - this is manifested by paresthesia and muscle cramps in the hands.

There may also be other non-specific symptoms such as increased fatigue, headache, tremors of the extremities, loss of appetite, sleep disturbances such as drowsiness. Vision may also deteriorate due to circulatory disorders.

Often, an increase in hemoglobin is recognized only when symptoms of varicose veins of the lower extremities appear, especially in the later stages. This develops due to the fact that women prone to this pathology have decreased venous tone, and an increase in hemoglobin levels aggravates these changes and a serious disease with blood stagnation develops. Such dilated veins can bleed and this has bad consequences if left untreated. Therefore, if a woman has varicose veins, even in a state of compensation, it is necessary to monitor the hemoglobin level, since these concepts are interrelated.

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Diagnostics elevated hemoglobin during pregnancy

Diagnosis of elevated hemoglobin is often accidental, since the pathology is asymptomatic. But attention should be paid to the patient's complaints, and if they concern a deterioration in general condition or headache, then it is imperative to conduct a general blood test to exclude anemia or, in this case, an increase in hemoglobin, which may have similar clinical signs.

It is necessary to carefully examine the woman and pay attention to the condition of the veins of the lower extremities. If they are tortuous or superficially located, then a laboratory study should be conducted to prevent the development of serious changes.

The tests that are carried out for this pathology and are the most informative are a general blood test, and also to control blood coagulation, a coagulogram must be performed. In a general blood test, erythrocytes with hemoglobin, platelets, leukocytes, and ESR are determined. Normal blood hemoglobin levels for women are 120-140 g/l, and for men - 130-160 g/l. If the decrease/increase in hemoglobin in pregnant women is less than 10%, then we are talking about physiological blood thickening, but if this indicator is more than 160 g/l, then you should pay attention to such a change.

It is also necessary to conduct a general urine analysis to exclude kidney damage, because they can also suffer from circulatory disorders, glomerular ischemia and dysfunction.

Instrumental diagnostics can be used when there is blood thickening and it is necessary to determine the degree of circulatory disorders in the heart, as well as peripheral vessels - veins. For this, an ultrasound duplex study is carried out to determine the blood flow velocity in the main organs. With an increase in hemoglobin, this indicator will be higher than the standard values. Also, to study the function of the veins against the background of such pathology to study the prognosis of the development of thrombosis and varicose veins, phlebography is carried out. This is a research method in which contrast is introduced into the veins and their filling with contrast, size, areas of expansion and tone are recorded.

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Differential diagnosis

Differential diagnostics of elevated hemoglobin during pregnancy should be carried out with acute conditions that may accompany such a condition. Therefore, it is necessary to exclude chronic latent blood loss in a woman, as well as other conditions of dehydration. To do this, first of all, it is necessary to determine the cause of the pathology and, if necessary, conduct fibrogastroscopy or ultrasound examination of the abdominal wall organs.

Treatment elevated hemoglobin during pregnancy

Treatment of this pathology at physiological levels of increase of indicators is not required. The possibility of treatment of increased hemoglobin during pregnancy is considered only when there are pronounced clinical symptoms associated with it and there is concomitant pathology.

In any case, you need to start with dietary recommendations. You need to drink enough water so that the rheological properties of the blood do not deteriorate. It is also necessary to replace red meat in the diet with white, which will reduce exogenous sources for hemoglobin synthesis. You also need to stick to a diet, which will help normalize your overall well-being.

Drug therapy may be indicated in case of a significant increase in the hematocrit index, then infusion therapy can be performed to restore the volume of circulating blood. For this, glucose-salt solutions are used in a one-to-one ratio. Infusion can be performed in a short-term mode, then within three days it is possible to restore the normal state of the indices.

There are no specific drugs to reduce hemoglobin levels, and in any case, it is not advisable to use them. Therefore, when a clinical picture of elevated hemoglobin appears during pregnancy, treatment is symptomatic. The use of unfractionated heparin or low-molecular heparins is not justified because these drugs are contraindicated during pregnancy. Drugs are used that improve the rheological properties of the blood and help normalize peripheral circulation without serious interventions in the blood coagulation system.

1. Antispasmodics help improve not only peripheral circulation, but also improve blood circulation in internal organs, preventing the development of their ischemia, and blood circulation in the fetus. They have no side effects on the fetus and therefore can be used as symptomatic therapy.

Papaverine hydrochloride is a myotropic antispasmodic that, when entering 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, causing their relaxation. It has a pronounced effect mainly on the arteries, which improves blood circulation with increased hemoglobin and blood thickening with a decrease in the severity of clinical symptoms. The method of using papaverine in this case is in 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 reactions with skin rash, nausea and vomiting, stool disorders with constipation, abdominal pain. There may also be symptoms from the cardiovascular system in the form of conduction disorders up to blockade, extrasystole, arterial hypotension. Increased sweating and drowsiness, as well as transient asymptomatic increases in liver enzymes, may occur.

Precautions - should be used with caution in case of concomitant hypotension.

1. Pentoxifylline is a drug from the group of peripheral vasodilators, which can be used for elevated hemoglobin as a means of eliminating the symptoms of ischemia, both peripheral and internal organ ischemia. The method of administration of the drug is tablets that should be washed down with water without chewing. The dosage of the drug is two tablets three times a day. Side effects are possible in the form of tachycardia, arrhythmia, sensation of heat, headache, pancytopenia, paresthesia. Precautions - if you have a tendency to bleeding or a history of peptic ulcer disease with bleeding, the drug is not recommended.

The use of other medications to treat elevated hemoglobin during pregnancy is not justified, since other drugs can harm the child or mother, or lead to complicated labor. Therefore, a choice must be made between these symptomatic drugs.

Vitamins can be used to maintain the general immune status of a woman and normalize the deficiency of microelements. Complex vitamin preparations containing ascorbic acid can be used, which improves the permeability of the vascular cell and prevents possible complications associated with increased hemoglobin. It is necessary to exclude iron intake during such vitamin therapy.

Surgical treatment of this pathology is not used. There may be indications for surgical intervention if the cause of increased hemoglobin is blood loss, which is characterized by an acute condition requiring urgent surgery.

Folk remedies for high hemoglobin during pregnancy

Folk treatment of elevated hemoglobin is of priority importance due to the fact that drug therapy in this case can harm the child. Therefore, many folk methods are used that help to normalize not only the rheological properties of the blood, but also the condition of the arterial and venous vascular wall. The main folk methods are as follows:

1. Ginger with cinnamon has very good properties of penetration into the vascular bed and normalization of hemoglobin and formed elements, and it also has excellent detoxifying 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. This tea should be drunk throughout the day, at least one and a half liters per day, if there is no swelling during pregnancy.
2. Wheat sprouts also thin the blood well. Before use, it is recommended to thoroughly wash the wheat and pour a small amount of water. Such wheat should be consumed raw, several grains per day, by adding to salads.
3. Horseradish root also has the ability to improve blood rheology and can be used as an antithrombotic agent, especially in cases of varicose veins. For medicinal purposes, it simply needs to be consumed in small quantities every day for a week.

Herbs also have many beneficial properties for the circulatory system and can normalize blood pressure, relieve headaches and improve peripheral circulation by flooding the body.

1. Tea made from currants, viburnum and rose hips has very useful properties for lowering hemoglobin levels. For such tea, you need to take 50 grams of each fruit per liter of water and make a compote, which you need to drink throughout the day in sufficient quantities.
2. Tincture of young chestnut skin is also widely used to treat this condition, but during pregnancy, the alcohol tincture should be replaced with water. To do this, take the skin of three chestnuts for 300 grams of water, pour boiling water over it and leave for three days, then take a tablespoon in the morning and evening.
3. Melissa and yellow burdock leaves should be poured with boiling water and drunk warm, half a glass in the morning on an empty stomach for five days.

Homeopathic remedies can also be used, as they can be used for a long time without harm to the child and are very effective.

1. Mercurius is a homeopathic remedy based on inorganic material. It is used to treat circulatory pathology with severe headaches. Method of application - under the tongue, dosage - ten drops of solution three times a day. Side effects are rare, allergic reactions are possible.
2. Vipera berus is a preparation from snake venom, which has antithrombotic properties. Dosage and method of administration of the drug - seven granules three times a day, keep in the mouth until completely absorbed. Side effects are possible in the idea of a cough, which has a dry character. Precautions - patients with a burdened allergic history should use the drug with caution.
3. Apis melifeca is a preparation based on honey bee extract, which is used for severe swelling of the face, legs, as well as concomitant thrombophlebitis against the background of elevated hemoglobin. The dosage of the preparation is 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 use in case of any allergic reactions to honey.
4. Esculus is a preparation based on horse chestnut, which has affinity for the uterus, so it is also used for circulatory disorders in the pelvic area and ischemia symptoms. The preparation is available in the form of drops. Method of administration and dosage - ten drops per glass of warm water. Side effects are rare, dyspeptic disorders are possible.

These folk and homeopathic remedies can be used for a long time before the birth period, if no complications arise and there is a positive dynamic in the symptoms.

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Prevention

The main complications that may result from elevated hemoglobin are associated with impaired rheological properties of blood and impaired peripheral circulation, including for the fetus. There may be consequences in the form of chronic fetal hypoxia, impaired uteroplacental circulation, premature aging of the placenta. This can also contribute to ischemia of the woman's vital organs - renal blood flow is impaired, renal hypertension develops with a further risk of preeclampsia. But all these changes can develop only with a long-term and malignant increase in hemoglobin levels and blood thickening.

Prevention of increased hemoglobin consists of non-specific measures. First of all, a pregnant woman should carefully monitor her diet and drinking regime to exclude dehydration. It is necessary to conduct all mandatory research methods during pregnancy in a timely manner to identify any pathologies that may be a consequence of this pathology.

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Forecast

The prognosis for normal pregnancy with an increase in hemoglobin levels within physiological values is positive with the restoration of the circulating blood volume and the prevention of complications.

Increased hemoglobin during pregnancy is not a common problem, the cause of which in most cases is the physiological processes of preparing the woman's body for childbirth. Therefore, the use of treatment in this case with medications is not recommended in the absence of pronounced clinical symptoms. Treatment should mainly be carried out against the background of normalization of rehydration and through the use of folk remedies.

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