ANAEMIA IN PREGNANCY

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ANAEMIA IN PREGNANCY

• AHMED ABDULWAHAB

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

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• Cont,
• MCHC remain stable.
• Serum iron and ferritin decrease because of
  utilization .
• Total iron binding capacity increases TIBC
• Iron requirement increases total of 1000mg in
  whole pregnancy.
• Moderate increase in iron absorption .
• Folate requirement increases

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• DEFINTION..
• WHO recommended that Hb concentration should fall
  below 11gm/dl in pregnancy to diagnose anemia.
• Incidence 30-50 pregnant women are having anemia
  at pregnancy.
• 90 have iron deficiency anemia .
• 5 folate deficiency .

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• CLINICAL FEATURE.
• Often asymptomatic.
• Diagnosed in routine screening .
• Other ,tiredness, dizziness ,fainting , pallor
  may be apparent

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• SCREENING .
• Routine screened by Hb concentration at the
  beginning of pregnancy .
• It is cheep and simple..
• It does not reveal the cause .

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• IRON DEFICENCY ANAEMIA .
• It is microcytic hypochromic . Reduced MCV .
  MCHC.
• Etiology .
• Increase demand in pregnancy due to expanding red
  cell mass, fetal requirement .If iron stores are
  depleted because of menstruation , recurrent
  pregnancy ,poor intake , anemia develops rapidly

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• CONSEQUENCES .
• Preterm labor.
• Infection
• Medical intervention during labor .
• Post partum blood loss.
• ? IUGR.

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• TREATMENT.
• Oral iron is effective when there is time .
• Hb increase 0.8 g/dl per week
• Ferrous salt is better absorbed than the ferric
  form .
• Side effect depends on the amount of the of the
  elemental iron .
• Choice depends on cost and patient tolerance .

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• Cont.
• Vitamin C helps absorption .
• Main side effect are gastro intestinal , gastric
  upset and constipation .
• Indication for parenteral thereby .
• Lack of compliance , severe GIT side effect, mal
  absorption
• Intera muscular iron sorbitol

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• Cont.
• Deep im it is painful cause discoloration of the
  skin .
• High level may be excreted before utilization .
• IV IRON .
• Iron saccharate cause more rapid rise in Hb and
  has fewer side effect. Compared

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• Cont
• To oral iron but more invasive , need admission
  to hospital , it is true alternative to blood
  transfusion.
• Blood transfusion ,
• Most rapid way to increase the Hb .
• Used when there is no time to correct anemia .
• Risks include allergy and transmission of
  infection

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• Cont.
• Prevention is possible with good balanced diet .
• Identification and treatment of iron deficiency
  prior to pregnancy are optimal .
• Routine iron supplementation in pregnancy improve
  in hematological indices.