anemia different types in pregnancy

1. ANAEMIA IN PREGNANCY - 1

2. Def/Degree
Commonest cause
Prevalence
Consequences
Requirement
Screening
Clinical Diagnosis
Aetiology
Laboratory diagnosis
Prevention
Treatment
Labour

3. Definition
Anemia is a condition where the red blood cell
number or their oxygen-carrying capacity is
insufficient to meet physiologic needs, and is
conventionally taken as a hemoglobin (Hb)
value that is less than two standard
deviation (SD) below the median value for
healthy matched population by age, sex,
altitude, smoking, and pregnancy status

4. Degree
World Health Organisation (WHO)
• Anemia in pregnancy as Hb values less than 11gm/ dl
Mild : 10 to 10.9
Moderate : 7 to 9.9
Severe : less than 7
• Anemia in postpartum females is defined as Hb less
than 10 g/dl

5. CAUSES
• PHYSIOLOGICAL
• IRON DEFICIENCY
• HEREDITARY RED CELL DISORDERS-
HEMOGLOBINOPATHIES(THALASEMIA,SICKLE
CELL ANEMIA),RED CELL MEMBRANE
DISORDERS(SPHEROCYTOSIS,ELLIPTOCYTOSIS)
• OTHER DEFICIENCIES-MEGALOBLASTIC
ANEMIA DUE TO VITAMIN B12,FOLATE
DEFICIENCY)
• AUTOIMMUNE HEMOLYTIC ANEMIA
• HYPOTHYROIDISM,CHRONIC KIDNEY DISEASE

6. Consequences

7. CONSEQUENCES
• Placental abruption (adjusted odds ratio [aOR] 1.36
with mild anemia, 1.98 with moderate anemia, 3.35
with severe anemia)
• Preterm birth (aOR 1.08 with mild anemia, 1.18 with
moderate anemia, 1.36 with severe anemia)
• Severe postpartum hemorrhage (aOR 1.45 with mild
anemia, 3.53 with moderate anemia, 15.65 with severe
anemia)
• Maternal shock (aOR 1.50 for moderate anemia, 14.98
for severe anemia)
• Maternal intensive care unit (ICU) admission (aOR 1.08
with moderate anemia, 2.88 for severe anemia)

8. Screening
• first trimester (or at booking)
• 24–28 weeks and at
• 36 weeks of gestation

9. Causes-Physiologic (dilutional)
• Plasma volume increases by 40-50%
• The RBC mass also increases, but to a
lesser extent (approximately 15 to 25
percent)

10. Causes-iron deficiency
Globally, the commonest cause for anemia in
pregnancy is IDA ( Iron Deficiency Anaemia )
Iron Deficiency (ID) : total content of iron in
the body
Iron Deficiency Anaemia (IDA): ID is severe
enough to reduce erythropoiesis

11. Prevalence

12. Requirement

14. Requirement
• The average daily requirement of iron has
been calculated as 0.8 mg/d in the first
trimester and increases to 7.5 mg/day in the
third trimester
• Average daily iron absorption from Indian diet
varies from 0.8 mg/d to 4.5 mg/d
depending on the type of staple used

15. History & Examination
SYMPTOMS-
• Fatigue
• Alopecia
• Pica
• Restless leg syndrome
SIGNS-
Pallor, koilonychia, atrophic tongue papillae,
glossitis and stomatitis

16. SYMPTOMS AND SIGNS
• Severe cases -congestive cardiac failure such
as dyspnoea,orthopnea, edema,
• Examination shows raised Jugular Venous
Pulse and pulmonary crepts

17. RISK FACTORS
• Pre-pregnancy menorrhagia
• Pre-pregnancy anemia
• Frequent child births,
• Worms infestation
• Gastrointestinal blood loss

18. Laboratory tests
IDA
• Mean Corpuscular Volume (< 80 fl )
• Mean Corpuscular Hemoglobin ( < 27 pg )
• Red Cell Distribution Width
• Peripheral Smear
ID
• Serum Ferritin ( < 30 mcg/dl )

19. Prevention
• Counselling on diet and nutrition
• Deworming( single dose albendazole 400 mg /
mebendazole 500 mg ) after first trimester.

20. Prevention
• Universal prophylaxis
IFA supplementation of 100 mg elemental iron and
500 μg of folic acid every day for at least 180 days
starting after the first trimester at 14–16 weeks
of gestation for all non-anemic pregnant women
followed by the same dose for 180 days
postpartum

22. Treatment
Depends on
• Severity of anaemia
• Stage of pregnancy
• Obstetric risks of the patient
• Non obstetric co morbidities
Methods
• Oral
• Parenteral
• Blood Transfusion

23. Oral Iron Therapy
• Maximum dose absorbed is only 100 to 200 mg
• No superiority of one iron salt/preparation over
another
• Avoid enteric coated and delayed release
preparations
• Take oral iron empty stomach or 1 h after meals
for better absorption preferably with vitamin C
rich product such as orange juice or guava

24. GI side effects
• nausea, constipation, diarrhea, indigestion,
and metallic taste
• Ferric salts have a superior GI tolerability
than Ferrous salts at the cost of reduced iron
absorption
• Reducing the frequency, content of oral iron
and changing it to an alternative preparation
or taking the iron with meals may
be employed to reduce GI side effects

25. Assessing response to oral iron
• Reticulocyte hb content ( as early as 3
days)
• Hb by I gm ( 2 weeks) & by 2 gm (4 weeks)
Sub optimal rise
• Check compliance
• Reconfirm diagnosis
• Indication for parenteral iron

26. Treatment completion
• Once the Hb is in normal range, 100–200
mg/day of iron should continue for at least 3
months and at least 6 weeks postpartum to
replenish the stores
• 60–100 mg/d oral iron should continue for at
least 3–6 months postpartum

27. Parenteral Iron
• Intramuscular Iron-not used at present due to
tissue staining and is painful
• Intravenous Iron

29. Copyrights apply

30. Intravenous Iron
• ID is confirmed by serum ferritin
• Informed Consent
• Resuscitative facilities
• Vitals to be monitored
• No test dose required
• Transient symptoms
• Single/ multiple

31. Ganzoni ‘s equation

32. Postpartum anaemia
• Poor QOL and depression
• 60–100 mg/d oral iron should continue
for at least 3–6 months postpartum
• Hb should within 48 h of delivery

33. Postpartum anaemia treatment
• Mild anaemia : oral iron 100 to 200 mg for
next 3 months
• Moderate anaemia : IV iron preparations
• Severe anaemia : blood transfusion before
discharge
• follow up CBC with serum ferritin should be
considered before discontinuation of iron
therapy at 3 to 6 months

34. Role of Transfusion
• Risks :
RBC allo-immunization, volume overload and
fetal hemolytic disease.
• A threshold Hb < 7 g/dl for transfusion
• Decision for transfusion is individualized

35. In Labour
• Delivery where transfusion facility is
available
• Intravenous access and cross matched
blood
• Active management of third stage of
labour

37. Prevention of other causes of
anemia
• Folic acid – Folic acid supplementation is
routinely recommended to prevent neural
tube defects.(5mg/day)
• Vitamin B12 – For individuals who consume a
strict vegetarian diet or those with anatomic
reasons to develop vitamin B12 deficiency
(eg, Roux-en-Y or biliopancreatic bariatric
surgery), the importance of supplemental
oral vitamin B12 should be emphasized.

38. Sickle cell disease (SCD)
• Transfusion in individuals with SCD;
• Genetic counseling for those with SCD or
sickle cell trait.
• Managing acute complications

39. Thalassemia
• Transfusion in certain individuals
• Genetic counseling
• Prenatal testing for thalassemia A
• Managing iron overload

40. Autoimmune hemolytic anemia
(AIHA)
• Transfusions
• Immunosuppressive therapies (eg,
glucocorticoids)
• Attention to possible anemia in the
neonate due to autoantibodies that cross
the placenta

41. THANK YOU