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Anaemia in Pregnancy
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Anaemia in Pregnancy

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Anaemia in Pregnancy

Anaemia in Pregnancy

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  • hi,
    may I know ur references for this info
    'For the purpose of treatment, at least 180mg/day is required'
    (slide #11)
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  • May I know what is your references ?
    Thank you so much
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  • nice presentation, thanks
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  • Thank you for posting this slides online. it really helps me to understand more about anaemia in pregnancy. If you wouldnt mind, can I have the soft copy to share them to my coursemates. Thank you. rachel_bluered@hotmail.com
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Anaemia in Pregnancy Anaemia in Pregnancy Presentation Transcript

  • GUIDELINES ON PREVENTION AND MANAGEMENT OF ANAEMIA IN PREGNANCY)
  • 1.Rountine Haemoglobin AssessmentShould be done at bookingIf normal, to be repeated during mid trimester ( 20-24/52) and around 36/52
  • 2.Iron Supplements In PregnancyT. Folic Acid 5mg OD in the first trimester ( 13/52) T Ferrous Fumarate 200mg -400mg OD + T Folid Acid 5mg OD or T Obimin 1 tablet/ day
  • 3.If Haemoglobin < 11g/dl(a) Low MCV and MCH ( result available on the same day), no history/ family history of haemoglobinopathy and clinically no apparent medical illness: Empirically treat as Iron Deficiency Anaemia Investigation: FBC with PBF Treatment: 1. T Ferrous Fumarate 400mg BD + T Folic Acid 5mg OD 2. Recheck Hb after 2-4 weeks - Hb expected to rise by 0.3g to 1g per week - If Hb rises as expected, continue with the same for the rest of the pregnancy
  • If Hb does not rise,- Ask about compliance and review full blood picture- If patient compliant, perform the followinginvestigations:serum ferritinHb electrophoresis Stool for ova and cyst Stool for occult blood BFMP if patient from an endemic area
  • (b) If MCV and MCH not available on the same day ( i.e. in KD orsmall MCH/ KK), no history/ family history ofhaemoglobinopathy and clinically no medical illnesses: Empirically treat as iron deficiency anaemia Investigation: FBC with PBF Treatment: o T Ferrous Fumarate 400mg BD + T folic Acid 5mg OD o Recheck Hb after 2-4 weeks ( Hb expected to rise by 0.3g -1g per week)
  • o If FBP shows microcytic hypochromic anaemia ( iron deficiency), - If Hb rises as expected, continue the same treatment for the rest of pregnancy - If compliance not an issue, perform the following investigations:  Serum Ferritin  Hb electrophoresis  Stool for ova and cyst  Stool for occult blood  BFMP if patient from an endemic area
  • o IF MCV and MCH is normal or high, Refer to Antenatal Combined Clinic/ Antenatal Specialist Clinic for further assessement and management
  • 4. Categorization of Women Using HaemoglobinAnd Serum Ferritin Serum Ferritin Haemoglobin Diagnosis ( microgram/ l) (g/dl)1 >12 >11 Normal, IDA excluded2 <12 >11 Storage iron depletion3 <12 <11 Iron deficiency anaemia4 >12 <11 Other causes of anaemia
  • 5. Women with IDA and unable to tolerate or non compliance to Ferrous Fumarate, Options include:a. Change to different preparation ( i.e. T Iberet 1 tab BD)b. Parenteral iron therapyc. blood transfusion
  • 6. Elemental Iron Doses: For prophylaxis against IDA, 30-100mg/day is enough For the purpose of treatment, at least 180mg/day is required
  • Amount of elemental iron in differentpreparations: Preparation Elemental iron (mg/ tab) 1. Ferrous Fumarate 60mg 2. Iberet 105mg of ferrous sulphate 3. Obimin/ Obimin plus/ 30mg of ferrous fumarate/ New Obimin ferrous sulphate
  • 7. Parenteral Iron Therapy No advantage over oral iron if the latter is well tolerated Only indicated in patients who cannot absorb iron, non compliant or developed serious side effect with oral iron Preparations: Iron Dextran ( Imferan) –Intramuscularly Dose: elemental iron needed (mg)= ( desire Hb – patient’s Hb) x weight(kg)x2.21+1000 Example: 60kg patient with Hb 7g/dl Elemental iron needed for her: (10-7)x60x2.21+1000= 1398mg Caution: small risk of hypersensitivity, should only given in hospital setting. Test dose of 50mg of IM Imferan given followed by 100mg daily until total dose meet
  • 8. Haemoglobin <11g/dl in patient known to bealpha or beta thalassemia trait:a. Prescribe Folic Acid 5mg dailyb. Check serum ferritin - If serum ferritin < 12 microgram/l, to treat as concurrent IDA
  • 9. Indications for blood transfusion duringantenatal period: Hb < 6g/dl Hb <8g/dl and POA >36/52 Moderate and severe anaemia in patient with known heart disease or severe respiratory disease Symptomatic anaemia Placenta praevia with Hb <10g/dl Patient who develops severe side effect to both oral and parenteral iron therapy
  • 10. Anaemic patient in labour: To transfuse if Hb <8g/dl and transfer to the hospital with specialist in high risk patient High risk patient with Hb between 8-10g/dl require at least 2 pint of blood ( GXM) AND transfer to the hospital with specialist if possible Patient with risk of PPH and anaemic is best delivered in the hospital with specialist In the event of advance labour where transfer is not possible, specialist input is required regarding the need for blood transfusion. GXM of at least 2 pint of blood must be made available in such patient
  •  Prophylactically, can start IV infusion of pitocin ( 20 unit in 500ml Hartman’s saline) to run over 4-6 hours after delivery of the babyIn grandmultipara, to start on 40 unit pitocin in 500mls Hartman’s infusion over 4-6 hoursClose maternal monitoring immediate postnatal period to be able to diagnose PPH early
  • Antenatal management Hb < 11g/dl, POA < 28 week No indication for blood transfusion, no apparent medical illness Empirically treat as iron deficiency anaemia -Investigation : Full blood picture (FBP) -Tab ferrous fumarate 400mg bd + Folic acid 500mcg od -Recheck Hb after 4 weeks (Hb expected to rise by 0.3g-1.0g per week) Review Hb and FBP
  • Microcytic hypocromic anaemia Not microcytic and but Hb not rises as expected Microcytic hypocromic hypochromic anaemia but Hb rises as anaemia expected Perform following investigation • Serum ferritin • Hb electrophoresis -Continue same treatment for Refer to combined or antenatal the rest of the pregnancy • Stool for ova and cyst specialist clinic - repeat Hb at 20-24/52 and • Stool for occult blood 36/52 • BFMP if patient coming from an endemic area Change FF with T. Iberet 1 tab BD Diagnosis: IDA but Hb did not Review Patient in 4/52 (if POA rise as expected <28/52 ) or 2/52 (if POA > 28/52) • Non compliantDiagnosis: Not IDA-Manage accordingly • Unable to tolerate oral preparation-Refer toCombined/Specialist Deworming/treatantenatal clinic malaria/address issue of occult blood loss if indicated Parenteral iron therapy ( IM Imferon)
  • Antenatal management Hb < 11g/dl, POA 28-36 weeks No indication for blood transfusion, no apparent medical illness To follow above flow chart but follow- up every 2/52 instead of 4/52
  • Antenatal management Hb < 11g/dl, POA 36 weeks No indication for blood transfusion, no apparent medical illness Empirically treat as iron deficiency anaemia -Investigation : Full blood picture -Tab Iberet 1 tab bd + Folic acid 500mcg od -Recheck Hb after 2 weeks or /and during labour (Hb expected to rise by 0.3g-1.0g per week)
  • THANK YOU…….