This document discusses anemia in pregnancy. It defines anemia as a hemoglobin level below 11g/dl. Anemia affects around 50% of pregnant women globally, and rates are higher in developing countries, up to 56%, often due to infections. Anemia can be physiologic, meaning it is a normal part of pregnancy, or it can be pathologic due to deficiencies in iron, folic acid, vitamin B12, hemorrhage, hereditary conditions, infections, or renal/bone marrow diseases. The most common cause of anemia in pregnancy is iron deficiency due to increased iron demands, poor diet, and infections. Treatment involves iron and folic acid supplementation. Megaloblastic anemia can also occur

1. DR LUNGU
Anemia in Pregnancy
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2. Defination of Anemia during Preg.
 Hemoglobin below 11gm/dl
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3. WHO
 11gm/dl or less
 By this standard, 50% of women not on
hematinics become anemic.
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4. Incidence
 Anaemia may affect 10% of pregnancies
in developed countries
 It is considerably commoner in developing
countries.
 Up to 56% of all women living in
developing countries are anaemic (Hb <
11 g/dl) due to infestations. 4

5. Classification
 Physiologic
 Pathologic:
a. Deficiency: Iron, Folic A., Vitamin B12
b. Hemorrhagic: APH, Hookworm
c. Hereditary: Thalassemia, Sickle, H. Hemolytic Anemia
d. Bone Marrow Insufficiency: Aplastic Anemia
e. Infections: Malaria, TB
f. Chronic Renal Diseases or Neoplasm.
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6. Concept of Physiologic Anemia
 Disproportionate increase in plasma vol,
RBC vol. and hemoglobin mass during
pregnancy
 Marked demand of extra iron during
pregnancy especially in second trimester
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7. Criteria for Physiologic Anemia
 Hb: 10gm%
 RBC: 3.2 million/mm3
 PCV: 30%
 Peripheral smear showing normal
morphology of RBC with central pallor
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9. Significance of Hypervolemia
1. To meet the demands of the enlarged uterus
with its greatly hypertrophied vascular system.
2. To protect the mother, and in turn the fetus,
against the deleterious effects of impaired
venous return in the supine and erect positions.
3. To safeguard the mother against the adverse
effects of blood loss associated with parturition.
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11. Most common causes of Anemia
 Iron loss : sweat, repeated pregnancy,
hookworm infestation and malaria
 Faulty absorption mechanism : due to
high incidence of intestinal infestation,
there is intestinal hurry
 Faulty diet habit : rich carbohydrate and
high phosphate reduce absorption of iron
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12. Factors lead to develop Anemia
 Increase iron demand
 Diminished intake of iron
 Disturbed metabolism
 Pre-pregnancy health status
 Excess demand
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13. Iron Deficiency Anaemia
 Symptoms: lassitude, weakness,
anorexia, palpitation, dyspnea
 Signs: Pallor, glossitis, soft systolic
murmur in mitral area due to physiologic
mitral incompetence
 Degree: Mild: 9-10.9g/dl
Moderate: 7-8g/dl
Severe: <7g/dl
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14. pallor
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15. Conjunctival Pallor
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16. Koilonychia
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17. Smooth Tongue
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18. Interpretation of plasma Iron
Iron TIBC Ferritin
Iron deficiency
anemia
Decrease Increase Decrease
Anemia of
chronic disease
Decrease Decrease Increase
Pregnancy Increase Increase Normal
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19. Normal Iron Requirements
 Iron requirement for normal pregnancy is 1gm
200 mg is excreted
300 mg is transferred to fetus
500 mg is need for mother
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20. Treatment
 Prophylactic: Supplement Fe – 60 mg
elemental Fe with Folic Acid
 Treatment doses : 200mg FeSo4 3 times
daily till
Hb level becomes normal, then
maintenance dose of 1 tab for
100 days
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21. Megaloblastic Anemia
 Due to impaired DNA synthesis, derangement in
Red Cell maturation
 It may be due to lack of VitB12 or Folic Acid or
both.
 Megaloblastic anemia in pregnancy is almost
always due to lack Folic Acid
 Vit B12 def is rare in Pregnancy
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22. Sign and symptoms
 Insidious onset, mostly in last trimester
 Anorexia and occasional diarrhoea
 Pallor of varying degree
 Ulceration in mouth and tongue
 Hemorrhagic patches under the skin and
conjunctiva
 Enlarged liver and spleen
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23. Angular Cheilosis
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24. Blood values
 Hb<10g/dl
 MCV>100micrometer3
 MCH>33pg, but MCHC is Normal
 Serum Fe is Normal or high TIBC is low
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25. Treatment
 Prophylactic
- all woman of reproductive age should be
given 400mcg of folic acid daily
 Curative
-daily administration of Folic acid 4mg
orally for at least 4 wks following delivery
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26. End
Any questions?
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