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BLOOD VOLUME

Increases by 30%

50% rise in plasma volume

+20% rise in erythrocyte volume

Increased in multiple

pregnancy, hydatidiform mole

Decreased in abortion, stillbirth

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PURPOSE

Fill up enlarged uterus and its

hypertrophied vessels

Meet fetal demands Protect mother against blood loss

Protect fetus against impairedvenous return ( like in supine posture)

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PLASMA VOLUME

Starts at 6 weeks

Most rapid in second trimester

Plateaus around 32 weeks

Total increase 50% (ml)

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ERYTHROCYTE VOLUME

Starts at 10 weeks

Peaks in second trimester

Continues till term

Total increase 20% (250 ml)

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0

10

20

30

40

50

60

plasma RBC blood

Physiological anemia of pregnancy

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results

Physiological anemia ( 11-12 mg/dl) as

against a normal 12-16mg/dl

Fall in erythrocyte count, hematocrit But total RBC volume increases

MCH, MCV , MCHC normal

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OTHERS

leucocyte count increase( 20000-25000 ) at

labour and puerperium

Platelet count increases

Total serum protein and albumin decrease

Immunoglobulins & fibrinogen increase

Hypercoagulability as all factors except2,11,13

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ANAEMIA IN PREGNANCY

Most common complication

Incidence in india- 40-90%

Accounts for 10-15% of maternalmortality

Occurs when Hb conc goes below11mg/dl (WHO) and 10mg/dl (FOGSI)

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causes

Directly related to pregnancy

Iron deficiency

Folate /B12 deficiency anemia due to acute blood loss

Anemia of chronic disease

Pregnancy induced hemolytic anemia

HELLP syndrome

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anemia not directly related

All anemias are worsened in pregnancy

Hemolytic anemias

Hemoglobinopathies

Aplastic anemia

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IRON DEFICIENCY ANEMIA

Most common

Commonly due to malnutrition

Others: parasite infestation, c/c bloodloss, malabsorption

Microcytic hypochromic

TOTAL IRON NEEDED: 1000 mg (fetus300, mother Hb expansion 500, shed 200)

in addition to 150-200mg each for delivery

loss and lactation

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An assesment..

normal requirement in non pregnant

women:1-2 mg/day

on average 5% of dietary iron absorbed So daily intake needed:20-22 mg/day

(marginal)

Pregnancy requirement: 4-6mg/dayso required intake 40-60 mg/day

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Scenario in india

Low socioeconomic status Poor intake

Vegetarian source(1% absorbed)

Parasitic infestations

Multiple pregnancies

Other c/c diseases

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MEGALOBLASTIC ANEMIA

Low plasma conc. and increased demand

for folic acid & vitamin B12

macrocytic Folate Requirement in pregnancy: 400

microgram/day

vitamin B12 -0.6-0.7 microgram/ day

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others

PIHA- rare, unexplained

HELLP syndrome-

microangiopahic, follows severe

preecclampsia

Anemia of a/c blood loss- normocytic

normochromic

Anemia of c/c diseases-c/c renalfailiure, c/c infection, inflammatory

diseases, neoplasms (normocytic

normochromic )

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