Megaloblastic anemia in Pregnancy
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Transcript of Megaloblastic anemia in Pregnancy
MEGALOBLASTIC ANEMIA
SURJEET ACHARYA
VMC
Objective
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CAUSES
CLINICAL FEATURES
TREATMENT
Introduction
Anemia due to
- deficiency in Vitamin B12
- deficiency in Folic acid
- disturbance in Folic acid metabolism
This is characterised by presence of
- megaloblast
- hypersegmented nuetrophil
INCIDENCE
0.5%-3% pregnant female (esp. Multigravida)
VITAMIN B12 deficiency is RARE in PREGNANCY
Normal folate store lasts for 6 weeks
PATHOGENESIS
receptor
Into plasma
Deoxy thymidilatemonophosphate
polyglutamates
monoglutamate
INTO PLASMA
CAUSES
VITAMIN B12
• Vegeterian diet (not even milk and milk products)Inadequate
intake
• Gastritis
• Gastrectomy
• Ileal bypass surgery
• Crohn’s disease
• Tumor of ileum
• PPH
Malabsorption
FOLIC ACID
• Nausea, Vomiting, LOA
• Decreased dietary intakeInadequate intake
• Multiple pregnancy
• Growing fetusIncreased demand
• Infection
• AnticonvulsantFailure of utilization
• Liver disorder
• Vitamin C deficiencyDiminished storage
• Infection- hookworm, malaria,
• Hemorrhage- peptic ulcer, hemorrhoidsAbnormal demand
Symptoms
Signs
PALLOR
GLOSSITISHEPATOSPLENOMEGALY
MCV increased
MCH raised
MCHC normal
Lymphopenia, Thrombocytopenia
Red cell folate <3ng/ml (N=2.8-8ng/ml)
Serum B12 <90pg/ml (N=300ng/ml)
Daily requirement during pregnancy
Vit B12 – 3 µg
Folic acid – 200 µg
MANAGEMENT
Prophylactic therapy
Curative therapy
Prophylactic therapy
All women of reproductive age – 400 µg of FA daily
Conditions with increased demand
Multiple pregnancy
Under anti convulsant therapy
Hemoglobinopathies
Associated chronic infections or diseases
Infants with neural tube defects
4 mg of FA daily started 1 month prior to conception upto 12 weeks of pregnancy
Curative therapy
4 mg of FA orally daily continued for
atleast 4 weeks following delivery
1 mg of FA daily with iron and
nutritious diet – pregnancy induced
MA
In general, always given with iron supplementation
Response by 7 – 10 days, evidenced by
Sense of well being
Increased appetite
Increased reticulocytes, leucocytes &
thrombocyte count
Rise in Hb level
Supplementary i.m 100 µg of vit B12
daily or on alternate days – response
to FA alone not adequate
Tab. Ascorbic acid 100 mg TID –
enhances FA action by converting it
into folinic acid
Thank you!