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Anemia in pregnancy
This document discusses anemia in pregnancy. It defines anemia and describes the normal physiological changes in pregnancy that can cause dilutional anemia. It then discusses the most common types of anemia in pregnancy, focusing on iron deficiency anemia. It describes the causes, clinical presentation, diagnosis, and treatment of iron deficiency anemia in pregnancy. It notes the importance of treating anemia to prevent maternal and fetal complications.
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Anemia in pregnancy
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- 4. CONTENTS DEFINITION TYPESOF ANEMIA IRON DEFICIENCY ANEMIA CAUSES CLINICAL PICTURE DIAGNOSIS TREATMENT OTHER TYPES OF ANEMIA INVESTIGATION PROTOCOL OF ANAEMIC PATIENT
- 5. ANEMIA A REDUCTION BELOWNORMAL LIMITS OF TOTAL CIRCULATING RED CELL MASS ANEMIA IN PREGNANCY NORMAL PHYSIOLOGICAL CHANGES A) PLASMA VOLUME….40-50% B) RED CELL MASS……18% HAEMDILUTION OR DILUTIONAL ANEMIA
- 6. WHO DEFINITION Hb. concentration< 11g/dl Haematocrit < 33% MILD 10-10.9g/dl MODERATE 7-10g/dl SEVERE <7 g/dl VERY SEVERE <4 g/dl
- 7. TYPES OF ANEMIAIN PREGNANCY COMMON TYPES Nutritional Deficiency Anemias 1) Iron deficiency 2) Folic acid deficiency 3) Vit B12 deficiency Haemoglobinopathies 1) Thalassaemia 2) Sickle cell disorder RARE TYPES Aplastic anemia Autoimmune hemolytic anemia
- 8. IRON DEFICIENCY ANEMIA INTERNAL IRONCYCLE IRON ABSORPTION early pregnancy 4mg 6.6mg avg diet 14mg 1-2mg absorbed INCR. IRON DEMAND 700-1400mg with avg of 1000mg fetus and placenta…500mg red cell expansion….500mg 1360mg loss at delivery ……..180mg lactation ……180mg amenorhea during lactation saves 360 mg’ AVG TOTALT INCR IN IRON DEMAND= 1360-360=1000MG On avg full iron stores(liver,spleen and bone marrow) contain 750-1000mg of iron
- 9. CAUSES• 1)DIETARY LACK Poverty Nutritionaldeficiency Food faddism Hyperemesis • 2)IMPAIRED ABSORPTION Worm infestations Amebiasis Giardiasis Inhibitors • 3)INCREASED LOSS A)GIT Peptic ulcer gastric/ colonic Ca Hemorrhoids Hookworm infestation Schistosomiasis Chronic malaria B)URINARY TRACT Renal, Pelvic Or Bladder tumors C) GENITAL TRACT Repeated pregnancies Menorrhagia Utrine CA
- 10. IRON DEFICIENCY ANEMIA EFFECTSOF ANEMIA MATERNAL EFFECTS High output cardiac failure Haemorrhage Infections Preeclampsia Maternal mortality FETAL EFFECTS LBW babies Preterm Cognitive and effective dysfunction
- 11. CLINICAL PICTURE MODERATE SYMPTOMSIncr. weakness easy fatiguibility MILD indigestion Asymptomatic loss of apetite SEVERE Palpitaions Severe Breathlessness Cardiac failure SIGNS pallor
- 12. DIAGNOSIS Serum ferritin(pg/l) 15-300 <10 Normal non pregna nt Normal pregnant Fe deficiency anemia in pregnancy Hb(g/dl)12-14 11-12.5 <11 Hematocrit(%) 37-45 33-38 <33 MCHC 32-36 32-36 <32 MCV(cubic microns) 80-100 70-90 <70 MCH(pg/cell) 27-34 23-31 <23 Serum Fe(microg/dl) 13-27 <13 TIBC(%) 33 <15 transferrin saturation(%) 25-35 15-30 <15
- 13. PERIPHERAL BLOOD FILM BONE MARROW EXAMINATION OTHERINVEST -Stool examination -malarial parasite -urine examination
- 14. IRON DEFICIENCY ANEMIA TREATMENT OBJECTIVES -NormalHb levels by last month of pregnancy -To replenish the iron stores (1) IRON THERAPY (2) BLOOD TRANSFUSION WHAT TO CHOOSE???
- 15. IRON THERAPY (1) ORALIRON PREPARATIONS - Ferrous sulphate(20%) Ferrous fumarate(30%)
- 16. (2) PARENTRAL IRON PREPARTIONS FeSorbitol (I/M) Fe Sucrose (I/V) INTRAVENOUS ROUTE 1) Fe sucrose complex (VENOFER) 5-10ml aliquots upto 3 weeks 2)Total dose Fe dextran
- 17. INTRAMUSCULAR ROUTE Fe sorbitolcitrate (JACTOFER) RESPONSE With in 2-3weeks Poor response -Inaccurate diagnosis -Non compliance -Continued blood loss -Coexisting infections -Concommitant folate deficiency
- 18. BLOOD TRANSFUSION INDICATIONS Anemia beyond36 weeks Anemia severe OR mild-moderte that fails to respond Excessive haemorrhage PACKED CELLS EXCHANGE TRANSFUSION TREATMENT OF OTHER PROBLEMS WORM INFESTATIONS Albendazole 400mg Mebendazole 100mg daily for 3 days MALARIA UTI BLEEDIND HAEMORRHOIDS
- 19. PROPHYLAXIS A) PREPREGNANCY ERA Fesuplement 60mg/d for 2-4 months Fortification B)DURING PREGNANCY Fe suplements With normal iron stores 30-60mg/d With empty iron stores 120-240mg/d 6months during pregnancy and 3 months post partum Treatment of infections
- 20. Dietary advise Food richin iron Cook food in iron utensils Inhibitors of absorption avoid too much cooking
- 21. INVESTIGATION PROTOCOL OF ANAEMICPATIENT High MCV (>99fl) Normal MCV (75-99fl) Low MCV (<75FL) ANAEMIA (Hb<11g/dl) Dec s. ferritin Dec TIBC Fe studies >3.5% HbA2 levels Normal Alfa thalassaemiaBeta thalassemia minor Family studies Normal (1.5-3.5%) Abn. RBC morphology Retics>2-3% Reticulocyte Count Normal or low Reticulocyte count Haemolysis Normal RBC morphology folate<3.4microg/l B12<20microg/l Hypersegmented neutrophils Folate level B12 level (peripheral smear) Haemoglobinopathies Other types of hemolytic anaemia Drugs autoimmune G6PD deficiency Drugs Chr disease Mild Fe def Folate or b12 def bleeding Fe deficiency
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