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.

1. ANAEMIA
IN PREGNANCY
(IRON DEFICIENCY)
សាស្រ្សាា ចារ្យវេជ្ជបណ្ឌ ិតឯក វ ៉េងលី
ឯកវេសផ្នែកស ភពនិងវោគស្រ្សាី,គត៌មានេិបតតិវេកូសាស្រ្សដថតនិងឆ្លុះមាត់សបូន
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2. សាស្រ្សាា ចារ្យវេជ្ជបណ្ឌ ិត ឯក វ ៉េ
ងលី
 សញ្ញា ប័ត្រវេជ្ជបណ្ឌ ិរឆ្ន ាំ២០០០
 វេជ្ជបណ្ឌ ិរឯកវេសផ្ននកសម្ភព​និង​វោគស្រសដ ី​ឆ្ន ាំ ២០០៤
 ជ្ាំនាញផ្ននកថរឆ្ លុះមារ់សបូ ន និងជ្ាំងឺមារ់សបូ នឆ្ន ាំ ២០១០
 ជ្ាំនាញផ្ននកគរ៌មានេ ិបរតិនិងវេកូសាស្រសដ ឆ្ន ាំ ២០១១
 ជ្ាំនាញផ្ននកេុះការ់ឆ្ លុះឆ្ន ាំ ២០១៣
 សាស្រសាត ចារ្យ ននសកលេ ិេាសាស្រសដ សុខាភិបាលវៅឆ្ន ាំ ២០១០
 េរីរត្បធានផ្ននកសម្ភពម្នទីរ្វពេយកាល់ ផ្ម្៉ែរឆ្ន ាំ ២០១២-២០១៥
 ត្បធានផ្ននកសម្ភពគលីនិកលុច្ស ២០១៥
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3. មាតិកា
1) WOMEN HEALTH IN CAMBODIA
2) ANAEMIA IN PREGNANCY
3) RISK FACTOR ANEMIA
4) NORMAL IRON CYCLE
5) SIGN AND SYMPTOM OF ANEMIA
6) MANAGEMENT
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4. 690
900
640
600
470 437
350
472
290
206
2008 Estimation developed by WHO,
UNICEF, UNFPA and World Bank
National estimation and CDHS
1990 1995 2000 2005 2010
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CDHS,2010 4

5. ូលវេតុនន រ្ណ្ៈភាពរ្បស់ទារ្ក
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6. អត្រានៃជ្ ងឺកងវះឈា ត្រកហ ចំវ ះស្រ្្ា ីក ព ុ
ជា
 ស្តសតីក ពលជាស្រ្បមាណ្ជា 45%ស្រ្តូេបានរ្កវ ើញថាមាន​ជ្ ងឺ កងវុះឈា ស្រ្កេ ។ កែលង
វនាុះផ្ែរ្ 38%ននស្រ្សាីទាំងវនាុះមានជ្ ងឺកងវុះឈា ស្រ្កេ កស្រ្ ិតស្រ្សាល
ស្រ្សាល ធ្យ ធ្ងន់ធ្ងរ្
38.4%
6.7%
0.2%
Adopted from: Table 3, CDHS2014
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7. ANAEMIA IN PREGNANCY
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.

8. Definition: Anemia Hb concentration should
fall below 11g/dl (or Ht <32%) in pregnancy
to diagnose anemia.
WHO grading of anemia
 Mild anemia 10 g/dl
 Moderate anemia 7- 10 g/dl
 Severe anemia < 7g/dl
ANEMIA IN PREGNANCY

9. Prevalence Anemia
 Prevalence in pregnant women
– 14 % - Developed Countries
– 51% - Developing Countries
– 65-75% - India
– 80 % leading to maternal deaths
 90% have iron deficiency anemia
 5% folic acid deficiency

10. Common Anemia in pregnancy
1) Nutritional Deficiency
- Iron deficiency
- Folic acid deficiency
- Vit. B12 deficiency
2) Hemoglobinopathies
- Thalassemia
- Sickle Cell Disease (susceptible hypoxia when O2 supply reduced)
- Rare types: Aplastic, Leukemia, Autoimmune hemolytic,
3) Red blood cell loss:
Menorrhagia 20-30%

11. RISK FACROR
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12. Normal iron metabolism
The primary function is oxygen transport.
Iron is absorbed by duodenum and jejunum
Average total body iron content 3500-4000 mg.
Approximately 2/3 found in hemoglobin,
Iron is also stored in RE cells (Bone marrow,
Spleen and liver) as hemosiderin and ferritin.
Transport of electrons within cells
Co-factor of essential enzymatic : Heme
Immunity: free radicals to destroy microbes

13. Normal Iron Cycle
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14. Normal Iron Cycle
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15. 15

16. IRON Requirements during Pregnancy

17. 17

18. តំរ្ូេការ្ ជាតិ ដែក
NIH Office of Dietary Supplements
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
(accessed: Sept 2015)
 សារ្ៈស្រ្បវោជ្ន៍ច្ំវ ុះមាត យ
 ជ្ួយែល់ការ្បវងកើនស្រ្ាប់ឈា ស្រ្កេ
 ការ្ រ្ជ្ំងឺវស្កសា្ ំង និងខ្វុះស្រ្ាប់ឈា
 កាត់បនថយនលប៉េុះ ល់វនសងៗកំឡលងវពលមានគភ៌
 សារ្ៈស្រ្បវោជ្ន៍ច្ំវ ុះទារ្ក
 ជ្ួយបវងកើតវកាសិកាឈា
 ជ្ួយែល់ ុខ្ងារ្ និងការ្េភិេឌ្ឍន៍ននខ្ួរ្កាល
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19. 19

21. Symptoms of IRON DEFICIENCY

22. Symptoms of IRON DEFICIENCY
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23. Effects of Anemia in pregnancy

24. INVESTIGATIONS
 Low Hemoglobin and Hematocrit
 RBC Indices: Low PCV, MCV, MCH, MCHC
 Low serum ferritin < 15 mcg/dl: most sensitive
 Low serum iron content (<30mcg/dl)
 Increased serum transferrin (>8 mg/l)
 Urine for hematuria
 Stool examination
 Electrophoresis Hb (Typing)
 Bone marrow examination.

25. MANAGEMENT (1)
 Objectives:
1- To achieve a normal Hb by end of pregnancy
2- To replenish iron stores
 Two ways to correct anemia:
1- Iron supplementation: Oral and Parenteral
2- Blood transfusion
 Choice of method: depends on 3 main factors:
1- Severity of the anemia
2- Gestational Age
3- Presence of additional risk factor

26. MANAGEMENT (2)
Improving diet rich in iron &
fruits & leafy vegetables
Treat worm infections,
maintain general hygiene
Food fortification with iron &
genetic modification of food
Iron & folic acid
supplementation in young
girls & during pregnancy

27. MANAGEMENT (3)
 WHO - 60 mg Elemental iron + 400
micro gram Folic acid/day * 6 months
& 3 months postpartum
 In anemia therapeutic doses are
120-200 mg /day
 Iron supplementation not
recommended in first trimester
– Higher incidence of miscarriage
– Birth defects
– Bacterial infection (bacteria grow
after taking iron from
supplementation)

28. MANAGEMENT (4)
Severe anemia: (Hb < 8gm/dl)
Parenteral therapy in IM or IV iron
- IM : Iron sorbitol
- IV : Iron sucrose
Blood transfusion:
 May be required to treat severe anemia near term or
when some other complication such as placenta
praevia present.
 Gross anemia
• Packed red cells transfusion
• Exchange transfusion

29. Side Effect of Fer
 Side effect of Fe Oral therapy:
. G. I upset.
. Constipation.
. Diarrhea.
Parenteral:
- Skin discoloration
- Local abscess
- Allergic reaction
- Fe over load.

30. SUMMARY
ANAEMIA IN PREGNANCY (Iron deficiency)
Most common form of anemia
Symptom of pathologic process
Primary manifestation is hematologic
Treatment requires:
– Replacement therapy
– Correction of underlying cause (if possible)
Iron excess more dangerous than iron
deficiency (Hemochromatosis)

31. Disease slide for public
Please consult your physicians for further information.
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