This document discusses anemia in pregnancy. It begins by providing background on the author, Dr. Shashwat Jani, and their qualifications. It then discusses the high prevalence of anemia among pregnant women, adolescent girls, and children in India. Anemia is a major direct and indirect cause of maternal mortality. The document defines anemia, describes the stages of iron deficiency anemia, and lists various causes of anemia in pregnancy. It outlines effects of anemia on both mother and fetus. The document discusses diagnostic tests and classifications of anemia, and various treatment options including oral iron supplementation, injectable iron, blood transfusions, and dietary modifications.
Obstetric analgesia and anesthesia 2021OBGYN Notes
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
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General anesthesia & obstetrics- c-section part ISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Obstetric analgesia and anesthesia 2021OBGYN Notes
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
* For further OBGYN notes - join us on telegram https://t.me/OBGYN_Note_Book
General anesthesia & obstetrics- c-section part ISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCSMd Rabiul Alam
Peripartum cardiomyopathy is one of the leading causes of death in obstetric patients since it is usually diagnosed incidentally. Echocardiogram remains the mainstay to diagnose it. Many of the peripheral hospitals are deficient of echocardiogram facilities, so there are possibilities to send the patient to OR without diagnosis. To manage such a case and bring out the success depends on quick detection of the problems & immediate medical intervention after confirming the diagnosis. Obviously, any surgical intervention requires lot of clinical experiences of the whole team, particularly the anesthesiologists.
Fetus is another patient needs to be given adequate attention and importance to find out whether it is alright or sick. This presentation will give a brief skeleton of tests to be done.
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCSMd Rabiul Alam
Peripartum cardiomyopathy is one of the leading causes of death in obstetric patients since it is usually diagnosed incidentally. Echocardiogram remains the mainstay to diagnose it. Many of the peripheral hospitals are deficient of echocardiogram facilities, so there are possibilities to send the patient to OR without diagnosis. To manage such a case and bring out the success depends on quick detection of the problems & immediate medical intervention after confirming the diagnosis. Obviously, any surgical intervention requires lot of clinical experiences of the whole team, particularly the anesthesiologists.
Fetus is another patient needs to be given adequate attention and importance to find out whether it is alright or sick. This presentation will give a brief skeleton of tests to be done.
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
Anemia in pregnancy &role of parenteral iron therapysusanta12
Iron deficiency anemia is most common anemia during pregnancy whic needs careful evaluation and treatment by Dr Susanta Kumar Behera,Department of Obstetrics & Gynecology, MKCG Medical College, Brahmapur,ODISHA,INDIA
Anemia in pregnancy (Iron deficiency)
WOMEN HEALTH IN CAMBODIA
ANAEMIA IN PREGNANCY
RISK FACTOR ANEMIA
NORMAL IRON CYCLE
SIGN AND SYMPTOM OF ANEMIA
MANAGEMENT
Introduction:
It is the commonest medical disorder of pregnancy.
Physiological changes.
Plasma volume increase by 50%.
Red cell mass increase by 25%.
Fall in Hb concentration and Ht due to haemodilution.
III Curso Anemia Perioperatoria. "Nuevas Perpectivas del Patient Blood Management." Servicio de Anestesiología y Reanimación. Hospital Universitario Puerta de Hierro. Majadahonda (Madrid). 8 y 9 de Mayo. Acreditado CFC
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Anemia In Pregnancy
Mother Of Evil
Dr. Shashwat Jani.Dr. Shashwat Jani.
M.S. ( Gynec)M.S. ( Gynec)
Diploma In Advance EndoscopyDiploma In Advance Endoscopy..
Consultant Assistant Professor,Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College,Smt. N.H.L. Municipal Medical College,
Sheth V. S. General Hospital,Sheth V. S. General Hospital, AhmedabadAhmedabad..
Mobile : +91 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Pregnancy -The most dangerous
journey of mankind
June 8, 2016June 8, 2016 22Dr Shashwat JaniDr Shashwat Jani
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3. Pregnancy -The most dangerous
journey of mankindAnemia is an Ice
Berg
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7. June 8, 2016June 8, 2016 Dr Shashwat JaniDr Shashwat Jani
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77
8. Where do we stand today ?Where do we stand today ?
•• Anemia prevalenceAnemia prevalence:: (NFHS 3: 2005-06)(NFHS 3: 2005-06)
20-80% amongst pregnant women20-80% amongst pregnant women
56% of adolescent girls, 30% boys56% of adolescent girls, 30% boys
79% of children79% of children (increasing trend compared to NFHS 2; 1998-99)(increasing trend compared to NFHS 2; 1998-99)
• Anemia as a direct cause of maternal
deaths: 15-20%
• Indirect cause: ~20%
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10. Definition
“Quantitative or qualitative reduction of Hb or
circulating RBCs or both resulting in
decreased O2 carrying capacity”
•• WHO –– Hemoglobin <11gm/dl & hematocrit <33%Hemoglobin <11gm/dl & hematocrit <33%
Postpartum Hb < 10 gm/dlPostpartum Hb < 10 gm/dl
•• CDCCDC ---- First and third trimesters : Hb <11gm/dlFirst and third trimesters : Hb <11gm/dl
Second trimester <10.5gm/dlSecond trimester <10.5gm/dl
- WHO. (2001) Iron deficiency anaemia: assessment, prevention and control, GenevaWHO. (2001) Iron deficiency anaemia: assessment, prevention and control, Geneva
- - Dowdle, W. (1989) Centers for Disease Control: CDC Criteria for anemia in children and childbearing-- Dowdle, W. (1989) Centers for Disease Control: CDC Criteria for anemia in children and childbearing-
aged women. Morbidity and Mortality Weekly Report 38, 400–404.aged women. Morbidity and Mortality Weekly Report 38, 400–404.
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12. Classification
• Physiological: - Hemodilution in preg,
- Negative iron balance,
-Increased Fe binding
capacity & absorbtion.
-Normocytic & Normochromic An
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13. • Pathological :
• Deficiency An- Fe, Folic acid,Vit B 12,
protein.
• Hemorragic An.- APH, worms, piles.
• Hemolytic An.- Sickle cell Anemia ,chronic
malaria, kala-azar, severe infection.
• Bone marrow insufficiency.
• Hemoglobinopathies.
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14. Stages involved in Iron Deficiency Anemia
June 8, 2016 14
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15. 1. ↓ in storage iron
∀ ↓ in tissue and marrow iron
∀ ↓ S. ferritin(< 20 mg/dl)
∀ ↑ S. transferrin
2. ↓ in iron for
erythropoiesis
∀ ↓ MCV & MCH
∀ ↓ Transferrin saturation
∀ ↑ Erythrocyte protoporphyrin
3. ↓ in peripheral blood Hb
∀ ↓ Hb & Hematocrit
4. ↓ in tissue oxygenation
• Clinical manifestation
EarliestEarliest
markermarker
of Ironof Iron
deficiencydeficiency
↓Hb % is a
very late
indicatorJune 8, 2016 15
16. Early
Pregnancy
2.5 mg / day
32 to 40
weeks
6.8 mg / day
TOTAL
800 – 1000 mg
20 to 32
weeks
5.5 mg / day
RBC =500mg
Fetus+Placenta
=450mg
Third stage blood loss =200mg
Total = 1150mg
Iron Requirement During Pregnancy
17. Why IDA is Common …???
Low Dietary Intake Of Iron ,
Chronic Intestinal Diseases Like Amoebiasis, Sprue,
Diarrhoea, Parasitic Infestation (Hook Worm)
Malaria , Schistosomiasis , Phytates In Diet,
Chronic Blood Loss ( Menorrhagia , Piles, Fissure In
Ano ---Apathy To Take Treatment)
Too many and too frequent pregnancies and plural
pregnancy.
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18. Clinical Features of Anaemia in Pregnancy
Symptoms Signs
Weakness Pallor .
Lassitude , tiredness , exhaustion Glossitis .
Indigestion Stomatitis .
Loss of appetite Oedema
Palpitation Hypoproteinaemia .
Breathlessness Soft systolic murmur in mitral area due to
hyperdynamic circulation
Giddiness / dizziness Fine crepitations at lung bases.
Swelling feet eye lids ( peripheral ) Pale nails . Platynaechoea . Koilonaechia
Generalized anasarca. Tenderness in sternum .
Blackouts in front of eyes on sudden standing Hepatic –splenic enlargement .
Symptoms of congestive cardiac failureJune 8, 2016 18
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19. Work up of Pregnancy with Anemia
Detailed H/o – age, parity, diet, chronic
bleeding, worm infestation, malaria, race etc
Examination
Pallor
Glossitis
Splenomegaly – hemolytic anemia
Jaundice – hemolytic anemia
Purpura – bleeding disorder
Evidence of chronic disease – Renal , TB
Anasarca & signs of cardiac failure in severe cases
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20. Diagnosis of IDA
Characteristics Calculation Normal Range IDA
Hb gm % Sahli’s method 11-15 < 11
Mean corpuscular volume(MCV) PCV/RBC 75-96 <75
Mean corpuscular HB Hb /RBC 27-33 <27
Mean corpuscular Hb Conc. (g/dl) HB / PCV 32-35 <32
PBF(peripheral Blood Film ) Normocytic
Normochromic
Microcytic
Hypochromic
Serum Iron (ug/dl) 60 -120 < 60
Total iron binding capacity (ug/dl ) 300- 400 >350
Transferrin Saturation < 15%
Serum Ferritin (mcg / dl ) 13-27 <12
Free erythrocyte protophyrin (ug/ml) <35 >50
Serum Transferrin Receptors increased
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21. Other Investigations are…
Zinc protoporphyrin levels- increased
Hypochromic Red Cell (HRBC).
Peripheral smear - Microcytic,hypochromic
RBC, anisocytosis, poikilocytosis, tear cells,
target cells.
stool ex. For occult blood
urine r/m for RBC & CAST
X –ray chest. For TB
Analysis of gastric juice.
S.protien.
B.M. study & osmotic fragility.
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22. Effects of Anemia on fetus:
Prematurity,
PROM,
IUGR,
IUFD,
Fetal programming & Disease of newborn –
Behavioral abnormalities, Poor performance on Bayley
Mental development index, decreased cognitive
function.
Prevention of adult Hypertension by Fe prophylaxis in
ANC
• HT associated with low Birth Wt & high ratio of Placenta
to Birth Wt.
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23. Effects of Anemia on pregnancy:
Increased incidence of PIH, APH, PPH,
Congestive cardiac failure at 30-32 wks,intra
partum & post-partum,
Puerperal sepsis,
Subinvolution,
Failing lactation,
Pulm. Venous thrombosis & Embolism.
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25. MANAGEMENT OPTIONS :
Pre – pregnancy :
Treat the cause before conception
Pre-pregnancy balanced diet, education and
health support.
Build up iron stores during adolescent
phase
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26. Iron rich food
Green leafy vegetables-chana sag,
sarson ka sag, chauli. Sowa,
salgam
Cereals - wheat, ragi, jowar, bajra
Pulses-sprouted pulses
Jaggery
Dryfruits
Animal flesh food - meat, liver
Vit C - lemon, orange, guava,
amla, green mango etc.
June 8, 2016 26
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30. Absorption of Ferrous Salt
♦ Iron salts are dissociated into bivalent or trivalent iron salts
♦ Diffuses as free iron ions through the upper part of the
gastrointestinal mucosa
♦ Taken up by transferrin and incorporated into ferritin.
♦ For binding to ferritin and transferrin ferrous iron has to be
converted into ferric iron by oxidation
♦ Highly reactive free radicals are produced during this
process
♦ All ionic iron including carbonyl iron are absorbed similarly
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31. ORAL IRON THERAPY :
• Ideal dose – 100mg per day (prophylactic)
• Ferrous gluconate, ferrous fumarate, ferrous
succinate, ferrous sulphate, ferrous ascorbate citrate
• Rise in Hb – 0.8 gm / dl / week
• Side effects -G I upset most common
• Pt. compliance not guaranteed
• Ineffective in pts with worm infestations
• Inconclusive evidence on benefit of controlled release
Iron preparation
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32. MYTHS OF ORAL IRON THERAPY :
• SR Preparations better tolerated Wrong
• Hb Preparation better bio-availability
Wrong
• Iron preparations should be given with meals Wrong
• Iron preparation have significant GI effects Wrong
• IPC/Carbonyl Iron are grossly better in efficacy Wrong
• Parenteral preparations work faster than Oral Wrong
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33. Indicators of iron therapy response :
Increase in Reticulocyte count
(Increases 3-5 days after initiation of therapy )
Increase in Hb levels. Hb increases 0.3 to 1 g/ week
Epithelial changes (esp tongue & nail ) revert to
normal
Hb concn. Is normal after 6 wks of therapy
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34. Parenteral Therapy :Parenteral Therapy :
Traditional IndicationsTraditional Indications
♦ Intolerance to oral iron
♦ Poor compliance to oral iron
♦ Gastrointestinal disorders
♦ Malabsorption syndromes
♦ Rapid blood loss
June 8, 2016 34
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35. ♦ Inability to maintain iron balanceInability to maintain iron balance
(haemodialysis)(haemodialysis)
♦ Patient donating large amount of bloodPatient donating large amount of blood
for auto-transfusion programmefor auto-transfusion programme
♦ Pregnant women with severe IDA,Pregnant women with severe IDA,
presenting late in pregnancypresenting late in pregnancy
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36. WHO States that…WHO States that…
‘ Transfusion should be
prescribed ONLY for conditions
for which there is NO OTHER
TREATMENT ’
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37. Parental Iron Therapy
Preparations
Iron Dextran (Imferon)- 50mg/ml. I.M.,I.V.
Iron Sorbitol Citrate (Jectofer)- only I.M.
use. Better absorption & less toxic reaction.
Low molecular wt Dextran.
Sodium ferric gluconate complex [SFGC].
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38. Iron Sucrose complex –
only I.V. use.
Dose IV inj. / infusion 100 mg diluted in 100
ml NS over 15 mins,
3 times / wk, max 600 mg per wk.
• Total dose infusion of Fe sucrose is not
recommended
• Recombinant human Erythropoietin
(rhEPO)- induces proliferation & differentiation of
erythriod precursors cells & prevents their apotosis.
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39. IRON SUCROSE
Dose calculated –
Wt in Kg x iron deficit x 2.2 + 1000 mg for iron
stores
Response - by increase in Hb level 1g/week
Increase in Reticulocyte count with in 5-10
days
Clinical symptoms improve
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40. Advantages of Iron sucrose:
high safety & stability, (Category B)
low tissue accumulation,
high availability for erythropoiesis
rapid Fe incorporation
No test dose required (No dextran)
Anaphylactic reaction are negligible.
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41. Disadvantage of parental
Iron:
1. Anaphylatic reaction - flushing of face, giddiness,
headache, drowsiness, fatigue, muscle cramps, abd colic,
dyspnea, chest pain, bronchospasm, syncope, tachycardia,
anaphylactic shock & death .
Inj. Adrenaline, hydrocortisone, avil, paracetamol should be
kept ready.
2. I.M. inj. site – local pain, hematoma , sterile abscess, skin
discoloration, fat necrosis, regional lymphadenopathy,
athralgia.
3. I.V. inj site - thrombophlebitis, venous spasm, skin staining due
to extravasation of drug in tissue.
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42. Remember…!!!
Oral iron must not be administered
concomitantly with a course of
IV iron.
Allow a period of 5 days after the final
dose of IV iron.
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42
43. Indications of
Blood Transfusion
Severe anemia first seen after 36
weeks of pregnancy
Anemia due to acute blood Loss –
APH & PPH
Associated Infection
Patient not responding to oral or
parenteral therapy
Anemic & symptomatic pregnant
women (dyspneic, with heart failure
etc) irrespective of gestational age
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44. FDA
Folic acid is needed in higher doses during
pregnancy because of the increased cell replication ,
taking place in fetus , uterus and bone marrow.
800 ug is required / day , but pre existing
deficiency is common especially in developing
countries . It is mainly due to inadequate diet /
intestinal malabsorption ( sprue ) syndrome .
Combined iron and folic acid deficiency
anemia is common in developing countries.
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45. Maternal complications PIH, Abruptio
placenta .
Fetal complications Folate deficiency
in mother can cause fetal neural tube defects ,
abortion , IUGR, premature / small for date
fetus and poor folate level in newborn .
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46. Diagnosis of FDA
Characteristics Normal range Folic acid deficiency
Hb 11-15gm% <11 gm%
MCV 75-96 > 96
Mean corpuscular HB 27 - 33 33
Mean corpuscular HB
Conc.
32-35 Normal
PBF Normocytic
Normochromic
Megalobastic , neutropenia ,
thrombocytopenia, hypersegmentation
of neutrophills
Serum Folate >3 <3
Red cell Folate >150 ng / ml < 150
Serum Iron 60-120 ug/dl Normal
Serum lactate
dehydogenase
HomoCysteine
Increased
IncreasedJune 8, 2016 46
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47. Treatment of FDA
WHO recommends 800ug / day in
pregnancy and 600ug / day during lactation
period .
Treatment for patient with Folic acid
deficiency anaemia should take 5mg folic acid / day
for > 4 weeks .
Response is observed by fall in LDH level in
3-4 days and increase in reticulocyte count in 5-8
days.
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48. B12 Deficiency
A rare cause of anaemia in pregnancy . ,
as daily requirement of 3ug is easily met with a
normal diet .
Pernicious anaemia due to absence of
intrinsic factor , resulting in decrease absorption
of Vit B12 is rare in pregnancy ., as it usually
causes infertility.
Parenteral Vit B12 ( cynocobalamin )
250ug / month is the treatment.
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49. THALASSEMIA
Characterized by impaired of one or more of globin chains .
ALPHA Thalassaemia when alpha chains are impaired . If only
one alpha chain is impaired the it is called Alpha Thalassaemia
Trait.
BETA thalassaemia When both Beta chains are impaired. Beta
Thalassaemia Trait if only one Beta chain is impaired.
Children With Beta Talassaemia usually die before reaching
reproductive age .
Repeated blood transfusion and Iron chelating therapy some
women remain alive , get married and become pregnant.
Need to be differentiated from IDA., by Blood indices and Hb F
and HbA 2 Levels .
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50. D/D Of IDA & Thalassaemia
Characteristics Normal Range IDA Thalassaemia
MCV 75-96 Reduced Very Reduced
Mean Corpuscular Hb 27-23 Reduced Very Reduced
Mean Corpuscular Hb
Conc.
32 -35 Reduced Normal
Fetal HB (HbF) <2%
Normal Raised
HbA2 2-3%
Normal Raised
Red cell width high Normal
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51. THALASSEMIA
If mother has Thalassaemia Trait , husband should
be investigated for Trait .If both partners are positive for
trait , prenatal diagnosis for foetal is indicated .
There is 1: 4 chances of fetus being Thalassaemia
major .
Therapeutic termination of pregnancy is indicted
in such situation .
If foetus has normal Hb Or Trait only, Pregnancy
can be continued and manage the anaemia by blood
transfusion as per need.
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52. Sickle cell Hbpathy
O.1- 1.0 % in west African and American blacks .
RBC have abnormal HB called HbS, having faulty
Beta chains in Hb, results from a single Beta chain
substitution of glutamic acid by Valine at colon 6 of
Beta globin chain .
When HbS is exposed to low O2 tension , Hb
precipitates in long crystals , cell become
elongated and sickle shape .
Red cell membrane changes make these abnormal
shaped cells more fragile –life spine reduces
resulting in anaemia .
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53. Sickle cell anemia
It may have serious implications in pregnancy and
women may develop Sickle cell crisis.
Patient frequently experience vicious circulation
events as progressive low O2 tension develops.
Sickle cell crisis is an emergency with infarction in
various organs due to sequestration of sickle cells , causing
severe pain more so in long bones.
It can happen any time in pregnancy , labour and
puerperium
Low Po2 in general anaesthesia can worsen the crisis
Treatment is by Iv hydration , O2 administration and
PCV transfusion.
Prenatal diagnosis is indicate in sickle cell Trait women
with sickle cell trait husband , with advice of MTP of an
affected pregnancy 53
55. Labor should be supervised
Proper counseling & consent to be taken
Blood (whole & packed) kept cross matched
Women nursed in propped up position
Intermittent O2 to be given
Precaution to prevent infection & blood loss
Strict aseptic precautions & minimal P/V exams
Prophylactic antibiotic can be given
Patent iv line but fluids are avoided
In decompensated patient diuretic given
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56. 2nd
& 3rd
Stage of labour
Second stage cut short by forceps or ventouse
Active management of 3rd
stage of labour to be done
Oxytocics, P/R misoprostol can be given after
delivery of fetus
Injection methergin iv contraindicated
Even normal blood loss may be tolerated poorly in
anemic patient
IV Frusemide given after delivery to decrease
cardiac load
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57. Post natal Care & Contraception
Early ambulation is encouraged
Hematinics are continued for 3-6 months
Watch for subinvolution , puerperal
sepsis, CHF, thrombo-embolism &
lactation failure
Avoid pregnancy at least for 2 years
LAM, barrier contraception, POP after 3
weeks, IUCD or permanent sterilization
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59. PREVENTION
• Iron supplementation during pregnancy According
to WHO 60 mg elemental iron and 250mg folic acid
daily for 6 months and additional 3 months in
postpartum period in low prevalence countries
• Treatment of hookworm infestation :
Single dose of Albendazole 400mg stat Or
Mebendazole 100mg BD for 3 days
• Improvements of dietary habits : Iron rich food
Cook food in iron utensils
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60. • Social services
• Improvement in sanitation
• Personal hygiene
• Better education of female regarding diet
• Contraception
• Food fortification Iron fortified salt like iodine
salt
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