Anemia In Pregnancy


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Anemia In Pregnancy

  2. 2. INTRODUCTION: • Anaemia is the commonest medical disorder in pregnancy • It is responsible for 40-60% of maternal deaths • It causes direct & indirect deaths;CHD,H-ge,Infection,PE • It increases PNM;PTL,IUGR, low iron stores & iron def. anaemia.
  3. 3. Factors required for erythropoiesis: • Proteins ; Erythropoietin • Minerals; Iron • Trace elements; Zinc,cobalt • Vitamins;Folic acid,B1+6+12,C • Hormones;Androgenes & T4 • Also;Vit A(cell growth),Zinc- needed for protein synthesis
  4. 4. DEFINITION: • A condition of low Hb,lying at two standard deviations below the median of a healthy population of the same age,sex and stage of pregnancy. • Cut-off ; for WHO= < 11g/dl and PCV < 0.33. For USA= < 10.5g/dl, during the second trimester
  5. 5. SEVERITY OF ANAEMIA CATEGORY SEVERITY Hb lev.(g/dl) I Mild 10.0-10.9 II Moderate 7.0-10.0 III Severe < 7.0 IV V.severe(de compensat.) < 4.0
  6. 6. Prevalence of Anaemia: • Globally = 40% • It is <20% in Europe up to >80% in the Indian sub-continent. • IDA is the commonest type • The balance between the iron ingested and lost dictates the iron nutritional status! • Food iron =provide 6mg/1000 calories • There are Haem & non-haem pools; • Haem absorption = 15-50%,not affected by inhibitors. Non-haem absorption-- is increased by enhancers & decreased by inhibitors.
  7. 7. Classification: 1. Iron deficiency 2. Megaloblastic–folic acid, vita B12 ( uncommon) 3. Haemolytic(infection, malaria) 4. Haemoglobinpathies; Sickle- cell, Thalathaemias. 5. Aplastic
  8. 8. • Factors affecting the Iron status IRON ABSORPTION IRON LOSS Enhancers: Haem iron, proteins, meat,vit C, alcohol fermentation, gastric acidity,ferrous iron, low iron stores, high altitude,haemolysis. Inhibitors: Phytates, calcium, tannins, tea & coffee, Physiological : Losses from skin and intestines, delivery, lactation, menses. Pathological : Hookworm and others H-ge from GIT
  9. 9. Iron bio-availability: • I] Low ; simple,routine diet of cereals,maize,rice,beans etc. + negligable amounts of meat,fish and vit C.low absorption[3-4%]. • II] Intermediate ; include some animal foods. • III] High ; rich in animal foods + generous amount of vit C. IRON REQUIREMENTS : Vary with maternal body weight and the maturity of the fetus; 2.5 mg/d in early pgy,5.5mg/d in 20-32/52,6-8mg/d from 32/52 Absorption < 10%; so iron
  10. 10. Investigations: • Aims: at finding; Degree, Type and Cause of anaemia. • Hb, Red cell count, PCV. • Peripheral blood smear ; Micro-, Aniso-, and Poikilocytosis. • Haem Indices; MCHC--most sensitive. • Anaemia: Hb<10gm%,RedCC< 4mln/mm³ PCV< 30%,MCH< 30%,MCV< 75µm³, and MCH< 25pg. • Others: Serum Fe< 30µg%, TIBC> 400µg%, Saturation< 10%,Ferritin< 15µg/L. Stools, Urine, Bone marrow study (not routinely).
  11. 11. CAUSES OF IRON DEFICIENCY: 1.Diet; habits, poverty, food fadism = when some types of food is not allowed due to customs ! 2.Worm infestation; Amoebiasis and Giardiasis. Shistosomiasis.Malaria. Excessive sweating and piles. 3.Multiple pregnancies. PREVENTION: 1.Prophylaxis of non-pregnants; giving them 60mg of iron daily for 2-4/12. 2.Iron supplementation during pgy ; WHO--- 60mg Fe + 250µg Folic acid 1-2/day, 2-3 inj. Of Imferon 250mg IM monthly. 3.Trt of hookworms; Albendazole 400mg/d or Mebendazole 100mg twice/d for 3 days. 4.Improvement of dietary habits. 5.Social services; education, personal hygiene , sanitation and alleviation of poverty. 6.Food fortification; of fish sauce,sugar,curry powder & salt with ferrous sulphate,gluconate,fumarate or succinate or chelated iron [bovine Hb concentrate and Fe-Na-EDTA]
  12. 12. TREATMENT • Accurate diagnosis of anaemia. • Admission: 1)Hb<7gm%.2)Other associated medical condition. • Choice of therapy depends on: a)Severity. b) Duration of pgy. c) Associated factors. • Options:1)Oral Fe.2)Parentral. 3)Blood transfusion. • TDI & Exchange blood transfusion to be used in certain circumstances. • Expected rise of Hb is 0.7-1gm/week. • Folic acid is added in most cases. Anti-- biotics & Anti-helminthics may also needed