Due to hemodilution anemia is pregnany is physiological change.On basis of hemoglobin level,anemia is classified in mild/moderate.severe.Most common type is iron defficiency.Before starting treatment some investigations are done to diagnose type of anemia.On basis of type,treatment vary.

1. ANAEMIA IN PREGNANCY
-Dr. NIRANJAN CHAVAN -DR. PARIKSHIT TANK

2. PANELIST
• DR.P.K.SHAH
• DR. VANDANA WALVEKAR
• DR. VINITA SALVI
• DR. SUCHITRA PANDIT
• DR. ARUN NAYAK
• DR. VANITA RAUT

3. CASE
• Mrs ABC 28 yrs old married since 6 yrs G3P2L2 B/D- 30 wks
registered in Sion hospital came with complaints of
weakness and easy fatiguability since 1 month
She gets easily tired with routine houseworks which she previously used
to do
No h/o breathlessness
No h/o chest pain, palpitation
No h/o fever, burning micturition
No h/o bleeding from any other site

4. • No h/o blleding pv in any antenatal visit
• No h/o jaundice
• No h/o easy bruisability/ petechial
• No h/o blood transfusion in the past
• No h/o any drug intake
• Patient was registered at 4th month of gestation in Sion hospital
2 antenatal visits, received 2 doses of TT
Has received haematinics but was not compliant due to gastritis

5. • Obstetrics history –
1st Male child 4 yrs old full term normal delivery 2.5 kg alive and well, No
admission
2nd Male child 1 yr old full term normal delivery 2.8 kg alive and well, No
admission
She was registered in both pregnancy and says she has taken haematinics
Contraceptive history – Patient has not used any contraception

6. • Past history – No significant past history
• Family history – No haemoglobinopathies in family
• Diet history – vegetarian diet

7. On examination-
• Conscious oriented
• Moderate built
• Pallor ++
• No e/o icterus cyanosis clubbing oedema
• No e/o glossitis, stomatitis
• No nail changes
• General condition – fair
• Afebrile
• Pulse – 98/m
• BP- 120/80
• CVS/RS – Normal

8. • Per abdomen- Abdomen is uniformly enlarged globular
Linea nigra and stria gravidarum present
Umbilicus everted. No scars
• On Palpation – uterus around 32 wks size, cephalic presentation,
FHS heard 140/bpm, Relaxed

9. • What all investigations you need to do….????
• Any specific investigations…??

10. • We call anemia a preventable problem. Why are we still talking about it
in 2018 as a potential killer disease in pregnancy?
• How does anemia contribute to maternal mortality and obstetric
morbidity?

11. • Does maternal anemia have a direct effect on the fetus? Do offsprings of
anemic mothers face significant health risks later in life?
• In your personal experience, do you see anemic women, especially severe
anemia, as commonly as you did when you started practice? To what do
you attribute this trend?

12. • What has changed in the last decade in the treatment of anemic women
with pregnancy?
• Which pregnant women with anaemia require hospital admission? Which
clinical situations demand a blood transfusion?

13. • What was the last anemia related emergency that you were faced with?
How did you manage the situation?
• What is the role of a hematologist in the management of anemia in
Pregnancy? When should a referral be considered?

14. • Do you recommend a hemoglobin electrophoresis as a part of a routine
antenatal care panel? Who should have this test?
• How should one judge the response to oral iron therapy? How soon would
a rise in Hb be expected? What should be the course of action if there is no
improvement after a month of treatment?

15. • How does one ascertain compliance with oral iron? Are there any tests? If
compliance is poor or there are side effects, what strategy should a clinician
adopt?
• Should we ever consider intramuscular iron in current practice? Is it
necessary to give a test dose of iron preparations meant for intravenous
use? What are the safe practices that one should follow in giving iron
parenterally?

16. • What is the place of erythropoietin in treating pregnant women with
anemia? Is it safe to use? Does it have a therapeutic advantage?
• Is FCM safe to use in pregnancy? Please highlight the latest guidelines on
this aspect. What is the current status of licencing?

17. HOW WILL YOU CLASSIFY ANAEMIA??
According to ICMR (Indian Council of Medical Research)
Mild – 8-11 g/dl
Moderate- 5-8 g/dl
Severe- less than 5 g/dl

18. CLASSIFICATION OF ANAEMIA

20. INVESTIGATIONS
• Complete Haemogram
• All blood routine examination
• Peripheral smear
• Retic count
• MCV, MCH, MCHC
• Sr. Iron, TIBC, Sr. ferritin
• Urine routine examination
• Stool routine examination
• Blood grouping

22. • Oral iron provides an inexpensive and effective means of restoring iron
balance in a patient with iron deficiency without complicating comorbid
conditions
• Numerous oral iron formulations are available

25. INTRAVENOUS PREPARATIONS
• IV iron is appropriate for patients who are unable to tolerate
gastrointestinal side effects of oral iron
• Older individuals, pregnant women (who already have gastrointestinal
symptoms related to the pregnancy), and individuals with existing
gastrointestinal disorders that may exacerbate oral iron side effects
• Those with severe/ongoing blood loss (eg, telangiectasias, varices)
• Gastric surgery (bypass, resection) that reduces gastric acid may severely
impair intestinal absorption of oral iron
• Malabsorption syndromes (celiac disease, Whipple's disease, bacterial
overgrowth) may limit absorption of oral iron

26. TO CALCULATE IRON REQUIREMENT