2. MOST COMMON MEDICAL DISORDER
IN PREGNANCY IN DEVELOPING
COUNTRIES.
20% OF MATERNAL DEATHS IN
DEVELOPING COUNTRIES.
PREVALENCE IN INDIA- 69-97%
3. LOW Hb CONC. RESULTING IN
DECREASE IN OXYGEN CARRYING
CAPACITY OF BLOOD.
WHO- Hb% <11GM%
PCV<33%
FOGSI AND ICMR- Hb%<10GM%
PRACTICALLY Hb <11GM% IS TAKEN
FOR ANEMIA
9. LIFE SPAN OF RBC-120 DAYS
HAEMOGLOBIN BROKEN INTO-
HEMOSIDERIN AND BILE PIGMENT
REQUIRES-
A)IRON AND TRACE ELEMENTS
B)VITAMIN- B-12 ,FOLIC ACID,VITAMIN -C
C)PROTEIN
D)ERYTHROPOIETIN- BY KIDNEY (90%)
,LIVER (10%)
10. AVERAGE IRON REQUIREMENT/DAY
THROUGHOUT PREGNANCY-
4 MG/DAY .
ABSORPTION OF IRON-10%.
HENCE 40-60 MG OF IRON REQUIRED /
DAY TO ACHIEVE 4-6 MG OF
ABSORPTION.
AVARAGE INDIAN DIET FAILS TO DELIVER
HENCE SUPPLEMENTATION REQUIRED.
11. A)FAULTY DIET
-diet rich in phosphates and phytates,tannic acid,calcium
-lack of awareness
-poverty and malnutrition
-food fadism
-faulty cooking
B)FAULTY ABSORPTION
-malabsorption
-diarrhoea
-worm infestation
-hypochlorohydria
C)IRON LOSS
-blood loss –piles,peptic ulcer,hookworm,menorrhagia
-through sweat
-chronic malaria
12. A)INCREASED DEMAND
-physiological anemia
-multiple pregnancy
-acute or chronic blood loss
B)DECREASED INTAKE
-nausea and vomitting
-intolerance to iron
C)LOW IRON RESERVE
-multiparity
-teenage pregnancy
D)DECREASED ABSORPTION
14. ASYMTOMATIC IN MILD
TIREDNESS
DIZZINESS
BREATHLESSNESS
LOSS OF APPETITE
INDIGESTION
PALPITATION
SWELLING OF LEGS OR ANASARCA
PICA
O/E-PALLOR
NAIL CHANGES
SSM ON CVS EXAMINATION
BASAL CREPTS IN FAILURE
15. INVESTIGATIONS-
HEMOGRAM WITH P/S
PCV
MCV,MCH,MCHC
RETICULOCYTE COUNT
SERUM IRON
TIBC
%SATURATION
S.FERRITIN
URINE R/M
RETICULOCYTE COUNT
STOOL FOR OVA AND CYST
LFT
S.PROTEIN
16. A) HB%-SAHLI OR
CYANOMETHEMOGLOBIN METHOD
B) P/S-LEISHMAN
STAIN.MICROCYTIC,HYPOCHROMIC,AN
ISOCYTOSIS ,POIKILOCYTOSIS,WITH
OR WITHOUT TARGET CELLS.
C)RETIC. COUNT- >3%
D) PCV- 32-36% N
<30% IN IDA
17. E) BLOOD INDICES-
MCV,MCH,MCHC- ALL REDUCED.
MCHC MOST SENSITIVE INDEX AS
NOT BASED ON RBC COUNT.
RBC<4 MILLION/MM3
PCV<30%
MCV<75 Fl
MCH<25PG
MCHC<30%
18. F)SERUM IRON-
<60 MICROGRAM/dl
(60-120 MICROGRAM/dl N )
G)TIBC(S. TRANSFERRIN)-
>400 MICROGRAM/dl
(300-400 MICROGRAM/dl N)
H) S.FERRITIN-
<15 MICROGRAM/L
(15-300 MICROGRAM/l or ng/ml )
MEASURED BY RIA.GIVES STATUS OF IRON
STORES.UNAFFECTED BY RECENT IRON.
19. I) % SATURATION OR TRANSFERRIN
SATURATION-
<10%
J) FEP –FREE ERYTHROCYTE
PROTOPORPHYRIN
>50 MICROGRAM/Dl
(<35 N )
K) RED CELL DISTRIBUTION
WIDTH(RDW)-
>15% IN IDA DUE TO HETEROGENOUS
POPULATION WITH DIFF. DIAMETERS.
20. L) S. TRANSFERRIN RECEPTOR-
SENSITIVE AND SPECIFIC MARKER
IN IDA IN PREGNANCY.VERY
EXPENSIVE.NOT ROUTINELY
AVAILABLE.
M)BONE MARROW-
23. PREVENT IDA IN ADOLESCENTS-
12 BY 12 INITIATIVE-AIM TO ACHIEVE
HB OF 12GM% BY 12 YRS USING
PROPHYLACTIC IRON AND FA
THERAPY.
DEWORMING-
MEBENDAZOLE 100 MG BD X 2
DAYS
ALBENDAZOLE 400 MG.
24. MIN. OF HEALTH ,GOVT. OF INDIA –
100 MG OF ELEMENTAL IRON WITH 0.5
MG FOLIC ACID IN SECOND HALF FOR
100 DAYS.
1 IRON TAB. OF IRON OF ANY FORM
ENOUGH FOR PROPHYLAXIS
PROVIDED THERE IS NO PREEXISTING
ANEMIA.
25. ORAL IRON –
SEVERAL IRON SALTS.
IRON ASCORBATE PREFERRED DUE
TO BETTER ABSORPTION.
ROUTE OF CHOICE AS RISE IN HB%
SAME IN ORAL AND PARENTERAL-
0.8GM% /WEEK.
DOSE- 1TDS -2 TDS
26. SIDE EFFECTS
STEP UP DOSE GRADUALLY TO AVOID
INTOLERANCE.
CHECK COMPLIANCE
RESPONSE OF THERAPY
FAILURE OF THERAPY
27. INDICATION-
.INTOLERANCE TO ORAL IRON .
.NON COMPLIANCE.
.ADVANTAGE OF REPLENISHING
IRON STORES.
AVAILABLE-
iron dextran(imferon)
iron sorbitol citrate(jectofer)
iron sucrose
ferric carboxy maltose
29. IRON DEXTRAN-
.100MG/DAY- 1 AMP (2 ML)- AST (1 ML ON
DAY 1) THEN 1 AMP ON ALTERNATE DAYS IN
UPPER OUTER QUADRANT OF BUTTOCK.
TDI(TOTAL DOSE INFUSION)
SIDE EFFECTS-painful abscess
discolouration,rigors,chest pain
,hypotension,fever,myalgia,arthralgia,headache,na
usea vomitting,lymphadenopathy,anaphylactic
reaction.
30. IRON SUCROSE-
SAFE.
NO TEST DOSE REQUIRED
IV BOLUS OR IV INFUSION-200 MG IV
EVERY ALTERNATE DAY
INJ.ADRENALINE,ANTIHISTAMINIC,
INJ. HYDROCORTISONE .
31. INDICATIONS-
SEVERE ANEMIA AFTER 36 WEEKS
ANEMIA DUE TO BLOOD LOSS
ASSOCIATED INFECTION
NOT RESPONDING TO THERAPY
ADV.-RAPID IMROVEMENT IN OXYGEN CARRYING
CAPACITY.
RISK-transfusion reaction,overloading heart,preterm
labour,infections transmitted.
PACKED CELLS PREFERRED OVER WHOLE
BLOOD.
32. SEVERE ANEMIA IN FAILURE
WITHDRAW PT. BLOOD AND CREATE
DEFICIT AND SIMULTANEOUSLY
TRANSFUSE.
33. PROPPED UP OR COMFORTABLE
POSITION
OXYGEN READY
IV LINE
ARRANGE BLOOD
A/B PROPHYLAXIS
CUT SHORT SECOND STAGE
ACTIVE MX OF THIRD STAGE
34. VIT B12 AND FOLIC ACID REQIRED FOR
DNA REPLICATION.DEFICIENCY-
ABNORMAL PRECURSORS CALLED
MEGALOBLAST.
FOLIC ACID DEFICIENCY MORE
COMMON.
INCIDENCE-3%
35. CAUSE-
.food lacking in green vegetables
prolonged cooking
malabsorption
antiepileptic drugs
increased demand in pregnancy and
lactation
hemolytic anemia ,malignancy
inflammatory conditions
h’ge
iron deficiency
37. S. IRON- N
RAISED LDH,S.BILIRUBIN MAY BE
RAISED
INCREASED HOMOCYSTEINE LEVELS
BONE MARROW-MEGALOBLASTS
TREATMENT-5MG FOLIC ACID /DAY
INJ.-15 MG FA AND 0.5 MG VIT B12 IM
FOR 7-10 DAYS
38. NOT AVAILABLE FROM PLANTS.ONLY
ANIMAL SOURCE.
CAUSE-VEGETARIANS,PERNICIOUS
ANEMIA,MALABSORPTION
C/F-ANEMIA ,PURPURA,SORE
TONGUE,DIARRHOEA,NEUROLOGICAL
MANIFESTATION
39. B12 LEVEL <90 MICROGRAM/L
S.HOMOCYSTEINE RAISED
DEOXYURIDINE SUPPRESSION TEST
USED TO DIFFERENTIATE BETWEEN
FA AND B 12 DEFICIENCY.
TREATMENT-B12 INJ IM DAILY OR
ALTERNATE FOR 7 – 10 DAYS.
41. MORE COMMON IN AFRICA
CARRIER STATE-1:100 IN INDIA
STRUCTURAL ABNORMALITY IN BETA
CHAIN.
RBC HAVE HbS .IN DEOXYGENATED
STATE AGGREGATES,POLYMERISES
AND DISTORTS RBS.
HEMOLYSIS,ANEMIA JAUNDICE
DX- SICKLING TEST,HIGH
S.IRON,ELECTROPHORESIS