Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Anemia in pregnancy

2,551 views

Published on

Anaemia in Pregnancy

Published in: Health & Medicine
  • Be the first to comment

Anemia in pregnancy

  1. 1. Anemia in pregnancy Update 1/11/2014 Juliana Mohd Basuni
  2. 2. definition  defined as a decrease in the amount of red blood cells (RBCs) or the amount of hemoglobin in the blood. Anemia". http://www.merriam-webster.com/. Retrieved 7 July 2014. Stedman's medical dictionary (28th ed. ed.). Philadelphia: Lippincott Williams & Wilkins. 2006. p. Anemia. ISBN 9780781733908.  It can also be defined as a lowered ability of the blood to carry oxygen.  Hematology : clinical principles and applications (3. ed. ed.). Philadelphia: Saunders. 2007. p. 220. ISBN 9781416030065.
  3. 3.  Hemoglobin in red blood cells is an oxygen-carrying protein that binds oxygen through its iron component.  Hemoglobin transports oxygen to most cells in the body for the generation of energy.  When hemoglobin levels are low less oxygen reaches the cells to support the body’s activities
  4. 4. Normal physiological changes in pregnancy  Plasma volume (50%)  Red cell mass ( 18 – 25 % depending on iron status)  Physiologic dilution which is greatest at 32 weeks gestation
  5. 5. WHO definition anemia in pregnancy  Anaemia as defined by the World Health Organization as haemoglobin levels of ≤ 11 g/dl.  UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva, World Health Organization, 2001  HCT < 32% gestation Hb 1st Trimester <11.0g/L 2nd Trimester < 10.5g/L 3rd Trimester < 11.0g/L
  6. 6. prevalence  varies  considerably because of differences in socioeconomic conditions, lifestyles and health-seeking behaviors across different cultures.  Anaemia affects nearly half of all pregnant women in the world:  52% in developing countries  23% in the developed world  UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva, World Health Organization, 2001
  7. 7. Prevalence WHO Global Database on Anemia 2008 Preschool children Pregnant women Non pregnant women during child bearing age world 47% 42% 30% malaysia 32% 38% 30%
  8. 8. classifcation Severity of anemia Hb concentration in pregnant women g/dL Treatment Mild 8 – 11 Oral haematinics or paranteral iron therapy. Moderate 6.0 – 8 Depending on period of gestation < 36 weeks gestation Treat with oral haematinics or paranteral iron therapy. If symptomatic admit to hospital. > 36 weeks gestation Paranteral iron in therapy. Consider blood transfusion. Severe < 6 Blood transfusion with 2 units packed cells.
  9. 9. problems  Anaemia is one of the most prevalent nutritional deficiency problems affecting pregnant women .  Thangaleela T, Vijayalakshmi P. Prevalence of anaemia in pregnancy. Indian J Nutr Diet 1994;31:26-32  The high prevalence of iron and other micronutrient efficiencies among women during pregnancy in developing countries is of concern and maternal anaemia is still a cause of considerable maternal & perinatal morbidity and mortality  Cutner A, Bead R, Harding J. Failed response to treat anaemia in pregnancy: reasons and evaluation. J Obstet Gynecol 1999;suppl.:S23-7  one of the world's leading causes of disability  one of the most serious global public health problems.
  10. 10. Anemia effects
  11. 11. Problems in postpartum period  Uterine Atony  PPH  Mortality ( 20% )  Depression  Emotional instability  Stress  Lower cognitive performance tests
  12. 12. Iron deficiency anaemia:  Requirements in pregnancy : 900 mg  Daily iron requirement in pregnancy : 4mg  2.5 mg/day in early pregnancy  6 – 8 mg/day from 32 weeks onwards  Absorption of iron is <10%, so an average of 40 mg dietary iron is required daily
  13. 13. ? Iron is important  vital for all living organisms because it is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport.
  14. 14. Causes Insufficient intake/ insufficient production ; nutrition , spacing , blood disease Increase loss : bleeding/ hemolysis , infestation , renal disease Increase demand : placenta , fetus , red blood cells expansion
  15. 15. Causes
  16. 16. Causes  Poor nutrition  Deficiencies of iron and other micronutrients  Malaria  Hookworm disease  Schistosomiasis  HIV infection  Haemoglobinopathies are additional factors  Van den Broek NR, White SA, Neilson JP. The relationship between asymptomatic human immunodeficiency virus infection and the prevalence and severity of anemia in pregnant Malawian women. Am J Trop Med Hyg 1998;59:1004-7
  17. 17. symptoms
  18. 18. signs
  19. 19. Ix  FBC FBP Peripheral Blood Smear Reticulocyte count  Serum Ferritin  UFEME , Stool Ova cyst  TIBC , Serum Iron  Hb Electrophoresis if required  Serum Folate /B12 if required
  20. 20. Management
  21. 21. Prevention of Anemia Women should be encouraged to undergo a pre-natal check up for early detection and treatment of iron deficient anemia. Proper spacing between two children ( contraceptions ) Having a well balanced diet rich in iron from adolescence. Regular screening for anemia. Fortification of ready-to-eat food with iron Avoid / Reduce smoking / alcohol consumptions
  22. 22. Management for IDA  Dietary advice : 10 – 15% absorption
  23. 23. management
  24. 24. Iron preparations
  25. 25. Treatment
  26. 26. Treatment  Iron Deficiency Anemia:  Treatment: 60 mg of elemental Fe (iron) orally every 6 to 12 hours (e.g. 2 to 4 times per day)  Prophylaxis: 60 mg of elemental Fe (iron) orally every day.  Recommended Daily Intake  Men: 8 mg elemental Fe (iron) orally once daily  Women: 18 mg elemental Fe (iron) orally once daily  Pregnant women: 27 mg elemental Fe (iron) orally once daily  Lactating women: 9 mg elemental Fe (iron) orally once daily  Parenteral & Oral Iron Products - GlobalRPh
  27. 27. Parenteral indications
  28. 28. Parenteral dosage  Iron Dextran ( Imferon / Cosmofer )  IM  Dose :  0.0442 x ( Desired Hb – Current Hb ) x Weight ( kg ) + 0.26 x Weight ( kg)  Iron Sucrose ( Venofer )  IV  Dose :  Prepregnancy Weight ( kg ) x Target Hb – Current Hb ) x 0.24 + 500mg  Cosmofer can also be given in IV route
  29. 29. Management options : Blood transfusion  Symptomatic anaemia  Hb < 6.0g% at 36weeks /close to delivery  Hb < 10.0g% in Placenta Praevia for elective CS
  30. 30. management  Treat infections  Treat worm infestations : Albendazole 400mg/ Mebendazole 500mg  Treat Schistosomiasis : Praziquantel  Treat Malaria : Chloroquine/Hydroxychloroquine
  31. 31. Management options Thalassaemia Syndromes
  32. 32. Conclusions  Screen anemia in pregnancy at booking  Rule out for thallasemia is necessary  Supplementation with iron  Dietary advice  Noted the contraindications of iron therapy  Continue supplemantation through postpartum until cessation of lactation
  33. 33. Thank you

×