ANAEMIA IN PREGNANCYANAEMIA IN PREGNANCY

AHMED ABDULWAHABAHMED ABDULWAHAB

• It is the commonest medical disorder of It is the commonest medical disorder of pregnancy.pregnancy.

• Physiological changes.Physiological changes.• Plasma volume increase by 50%.Plasma volume increase by 50%.• Red cell mass increase by 25%.Red cell mass increase by 25%.• Fall in Hb concentration and Fall in Hb concentration and

haematocrit due to haemodilution.haematocrit due to haemodilution.• MCV increase secondary to MCV increase secondary to

erythropoiesis.erythropoiesis.

• Cont,Cont,

• MCHC remain stable.MCHC remain stable.

• Serum iron and ferritin decrease because of Serum iron and ferritin decrease because of utilization .utilization .

• Total iron binding capacity increases TIBCTotal iron binding capacity increases TIBC

• Iron requirement increases total of 1000mg Iron requirement increases total of 1000mg in whole pregnancy.in whole pregnancy.

• Moderate increase in iron absorption .Moderate increase in iron absorption .

• Folate requirement increasesFolate requirement increases

• DEFINTION..DEFINTION..• WHO recommended that Hb WHO recommended that Hb

concentration should fall below concentration should fall below 11gm/dl in pregnancy to diagnose 11gm/dl in pregnancy to diagnose anemia.anemia.

• Incidence 30-50% pregnant women Incidence 30-50% pregnant women are having anemia at pregnancy.are having anemia at pregnancy.

• 90% have iron deficiency anemia .90% have iron deficiency anemia .• 5% folate deficiency .5% folate deficiency .

• CLINICAL FEATURE.CLINICAL FEATURE.

• Often asymptomatic.Often asymptomatic.

• Diagnosed in routine screening .Diagnosed in routine screening .

• Other ,tiredness, dizziness ,fainting , Other ,tiredness, dizziness ,fainting , pallor may be apparent pallor may be apparent

• SCREENING .SCREENING .

• Routine screened by Hb Routine screened by Hb concentration at the beginning of concentration at the beginning of pregnancy .pregnancy .

• It is cheep and simple..It is cheep and simple..

• It does not reveal the cause .It does not reveal the cause .

• IRON DEFICENCY ANAEMIA .IRON DEFICENCY ANAEMIA .• It is microcytic hypochromic . Reduced It is microcytic hypochromic . Reduced

MCV . MCHC.MCV . MCHC.• Etiology .Etiology .• Increase demand in pregnancy due to Increase demand in pregnancy due to

expanding red cell mass, fetal expanding red cell mass, fetal requirement .If iron stores are depleted requirement .If iron stores are depleted because of menstruation , recurrent because of menstruation , recurrent pregnancy ,poor intake , anemia develops pregnancy ,poor intake , anemia develops rapidly rapidly

• CONSEQUENCES .CONSEQUENCES .

• Preterm labor.Preterm labor.

• Infection Infection

• Medical intervention during labor .Medical intervention during labor .

• Post partum blood loss.Post partum blood loss.

• ? IUGR.? IUGR.

• TREATMENT.TREATMENT.• Oral iron is effective when there is time .Oral iron is effective when there is time .• Hb increase 0.8 g/dl per week Hb increase 0.8 g/dl per week • Ferrous salt is better absorbed than the Ferrous salt is better absorbed than the

ferric form .ferric form .• Side effect depends on the amount of the Side effect depends on the amount of the

of the elemental iron .of the elemental iron .• Choice depends on cost and patient Choice depends on cost and patient

tolerance .tolerance .

• Cont.Cont.

• Vitamin –C helps absorption .Vitamin –C helps absorption .

• Main side effect are gastro intestinal , Main side effect are gastro intestinal , gastric upset and constipation .gastric upset and constipation .

• Indication for parenteral thereby .Indication for parenteral thereby .

• Lack of compliance , severe GIT side Lack of compliance , severe GIT side effect, mal absorption effect, mal absorption

• Intera muscular iron sorbitol Intera muscular iron sorbitol

• Cont.Cont.

• Deep im it is painful cause Deep im it is painful cause discoloration of the skin .discoloration of the skin .

• High level may be excreted before High level may be excreted before utilization .utilization .

• IV IRON .IV IRON .

• Iron saccharate cause more rapid rise in Iron saccharate cause more rapid rise in Hb and has fewer side effect. Compared Hb and has fewer side effect. Compared

• ContCont• To oral iron but more invasive , need To oral iron but more invasive , need

admission to hospital , it is true alternative admission to hospital , it is true alternative to blood transfusion.to blood transfusion.

• Blood transfusion ,Blood transfusion ,• Most rapid way to increase the Hb .Most rapid way to increase the Hb .• Used when there is no time to correct Used when there is no time to correct

anemia .anemia .• Risks include allergy and transmission of Risks include allergy and transmission of

infectioninfection

• Cont.Cont.

• Prevention is possible with good balanced Prevention is possible with good balanced diet .diet .

• Identification and treatment of iron Identification and treatment of iron deficiency prior to pregnancy are optimal .deficiency prior to pregnancy are optimal .

• Routine iron supplementation in Routine iron supplementation in pregnancy improve in hematological pregnancy improve in hematological indices.indices.