Anemia during pregnancy

1. ‫الرحیم‬ ‫الرحمن‬ ‫هللا‬

2. Introduction
 Anemia is a lack of functioning red blood cells (RBCs) that leads
to a lack of oxygen-carrying ability, causing unusual complications
during life time.
 These RBCs are produced in the bone marrow. They have a life
expectancy of about 120 days. Among other things, the body needs
iron, vitamin B12 & folic acid for erythropoiesis.
 If there is a lack of one or more of these ingredients or there is an
increased loss of RBCs, anemia develops.
 Any patient with a Hb of less than 11 gm/dl to 11.5 gm/dl at the
start of pregnancy will be treated as anemic.

3. Incidence
 In tropical countries, the incidence of anemia in
pregnancy is about 40-80%.
 In developed countries, it ranges between 10-20%.
 It is responsible for 20% of maternal death in
developing countries.

4. Classification causes of anemia in
pregnancy
Grossly classified into two types:
 (A) Pathological anemia in pregnancy.
 (B) Physiological anemia in pregnancy.

5. Pathological anemia in pregnancy
Pathological Anemia is further sub-classified into:
1. Deficiency Anemia
 Iron deficiency
 Folic acid deficiency
 B12 deficiency
 Protein deficiency

6. 2. Hemorrhagic
 Acute hemorrhagic: Following bleeding in early month of
pregnancy or APH
 Chronic hemorrhagic: as by hookworm infestation, GI
(gastrointestinal) bleeding.
1. Hereditary:
 Thalassemias – Haemolobinopathies.
 Hereditary hemolytic anemia – RBCs defects.
2. Bone Marrow insufficiency: as by radiation, marrow suppressant
drugs.
3. Anemia of infection – as by malaria tuberculosis
 4. Chronic diseases : as in nephropathies & neoplastic disorders.

7. (B) Physiological Anemia
 During pregnancy there is disproportionate increase in
plasma volume upto 50%, RBC 33% and Hb 18-20% mass.
 In addition there is marked demand of extra iron during pregnancy
especially in the second half of pregnancy.
 So physiological anemia is due to combined effect of hemodialution
& negative iron balance.
Criteria of Physiological Anemia include
 Hb% - 10 gm r less,
 R.B.C – 3.5 million/mm3,
 P.C.V – 30%,
 PBF – Normal morphology with central pallor.

8. Common Causes
Iron-deficiency anemia
 This is the leading cause of anemia in most common type of
anemia during pregnancy. Approximately 15% to 25%of all
pregnancies experience iron deficiency.
 Iron is a mineral found in the red blood cells and is used to carry
oxygen from the lungs to the rest of the body, as well as helps the
muscles store and use oxygen.
 When too little iron is produced, the body can become fatigued and
have a lowered resistance to infection.

9. Folate-deficiency anemia
 Folate refers to Folic Acid which is a water-soluble vitamin
that can help prevent neural tube defects during pregnancy.
 Folic Acid is a common supplement taken by pregnant
women, but it can also be found in fortified foods such as
cereals, leafy vegetables, bananas, melons, and legumes.
 A diet lacking folic acid can lead to a reduced number of
red blood cells in the body, therefore leading to a
deficiency.

10. Vitamin B12 deficiency anemia
 Vitamin B-12 is also a necessary vitamin for the
body to have to help with the production of red
blood cells.
 Although some women may consume enough B-12
in their diet, it is possible their body cannot process
the vitamin, and this causes them to have the
deficiency

11. Sign and Symptoms of Anemia During
Pregnancy
The most common symptoms of anemia during pregnancy are:
 Pale skin, lips, and nails
 Feeling tired or weak
 Dizziness
 Shortness of breath
 Rapid heartbeat
 Trouble concentrating

13. Risk Factors
You are at higher risk for becoming anemic during your
pregnancy if you:
 Have two pregnancies close together
 Are pregnant with more than one child
 Are vomiting frequently due to morning sickness
 Do not consume enough iron
 Have a heavy pre-pregnancy menstrual flow

15. Diagnosis
 Hemoglobin test. It measures the amount of hemoglobin -
- an iron-rich protein in red blood cells that carries oxygen
from the lungs to tissues in the body.
 Hematocrit test. It measures the percentage of red blood
cells in a sample of blood.

16. Differential Diagnosis of deficiency
anemia in pregnancy
 Infection,
 Nephritis,
 Hemoglobinnopathies.

17. Treatment of anemia in Pregnancy
Curative treatment:
 - Hospitalisation, if Hb level is below 7.5 gram percent.
General treatment:
 - Diet – balanced diet rich in protein, vitamins and iron
 - Antibiotic for infections
Specific Therapy as needed:
 - Oral,
 - Parental,
 - Blood transfusion.
Depending on
 - Severity of anemia,
 - Duration of pregnancy,
 - Associate complicating factor

18. Preventing Anemia
To prevent anemia during pregnancy, make sure you get enough
iron. Eat well-balanced meals and add more foods that are high in
iron to your diet.
Aim for at least three servings a day of iron-rich foods, such as:
 lean red meat, poultry, and fish
 leafy, dark green vegetables (such as spinach, broccoli, and kale)
 iron-enriched cereals and grains
 beans, lentils, and tofu
 nuts and seeds
 eggs

19. Cont..
Foods that are high in vitamin C can help your body
absorb more iron. These include:
 citrus fruits and juices
 strawberries
 kiwis
 tomatoes
 bell peppers

21. Complications of severe anemia
During pregnancy
 Pre-eclampisa,
 Recurrent
infection,
 Heart failure,
 Preterm labour,
During labor
 Uterine inertia,
 PPH,
 Cardiac failure,
 Shock.
During puerperium
 Puerperal sepsis,
 Sub-involution,
 Failing lactation.

22. Reference
 https://www.webmd.com/baby/guide/anemia-in-pregnancy
 http://www.hematology.org/Patients/Anemia/Pregnancy.aspx
 https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-
depth/anemia-during-pregnancy/art-20114455
 http://www.msdmanuals.com/professional/gynecology-and-obstetrics/pregnancy-
complicated-by-disease/anemia-in-pregnancy

23. Thank You