Anemia in Pregnancy

August 16, 2011

a. Deficiency: Iron, Folic A., Vitamin B12 b. Hemorrhagic: APH, Hookmworm c. Hereditary: Thalassemia, Sickle, H. Hemolotyic Anemia d. Bone Marrow Insufficiency: Aplastic Anemia e. Infections: Malaria, TB f. Chronic Renal Diseases or Neoplasm





Labs:

-Hb 7.1 gm/dl, Hct 23%
-WBC 5,400/mm3 (differenctial is normal)
-Platelets 450,000/mm3
-Mean Corpuscular volume (MCV) is 74 fl (normal 85-95f l)
-Red cell Distribution Width (RDW) is 17.1% (normal 13-15).


Hemoglobin below 11gm/dl in 1st and 3rd trimester and below 10.5gm/dl in second trimester.


11gm/dl or less
By this standard, 50% of women not on hematinics become anemic


Anaemia may affect 1-% of pregnancies in developed countries and is considerably commoner in developing contries, where it is a major source of meternal morbidity and a contributor to mortality.
Up to 56% of all women living in developing countries are anaemic (Hb < 11 g/dl) due to infestations


Physiologic
Pathologic:

a. Deficiency: Iron, Folic A., Vitamin B12
b. Hemorrhagic: APH, Hookmworm
c. Hereditary: Thalassemia, Sickle, H. Hemolotyic Anemia
d. Bone Marrow Insufficiency: Aplastic Anemia
e. Infections: Malaria, TB
f. Chronic Renal Diseases or Neoplasm


Disproportionate increase in plasma vol, RBC vol. and hemoglobin mass during pregnancy
Marked demand of extra iron during pregnancy especially in second trimester


Hb: 10gm%
RBC: 3.2 million/mm3
PCV: 30%
Peripheral smear showing normal morphology of RBC with central pallor


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


Normal hemoglobin by gestational age in pregnant women taking iron supplement
12 wks 12.2 [11.0 - 13.4]
24 wks 11.6 [10.6 - 12.8]
40 wks 12.6 [11.2 - 13.6]

 


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 absoprtion of iron


Increase iron demand
Diminished intake of iron
Disturbed metabolism
Pre-pregnancy health status
Excess demand


Symptoms lassitude, weakness, anorexia, palpitation, dyspnea
Signs Pallor, glossitis, soft systolic murmur in mitral area due to physiologic mitral incompetence
Degree: Mild 8-10gm%
              Moderate: 7-8gm%
              Severe: <7gm%




Smooth Tongue

Interpretation of plasma Iron

 IronTIBCFerritin
Iron deficiency anemiaDecreaseIncreaseDecrease
Anemia of chronic diseaseDecreaseDecreaseIncrease
PregnancyIncreaseIncreaseNormal


Iron requirement for normal pregnancy is 1gm
              200 mg is excreted
              300 mg is transferred to fetus
              500 mg is need for mother
Total volume of RBC inc is 450 ml
              1 ml of RBCs contains 1.1 mg of iron
             450 ml X 1.1 mg/ml = 500m mg
Daily average is 6-7 mg/day

 


Prophylactic: Supplement Fe - 60 mg elemental Fe with Folic Acid
Curative: 200mg FeSo4 3 times daily till Hb level becomes normal, then maintenance dose of 1 tab 100 days


Due to impaired DNA synthesis, derangement in Red Cell maturation
It may be due to Def. of VitB12 or Folic Acid or both.
Megaloblastic anemia in pregnancy is almost always due to Folic Acid def.
Vit B12 def is rare in Pregnancy because its need is less in amount and amount is met with any diet that contains animal products.


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



Hb < 10gm%
Hypersegmentation of neutrophils
Megaloblast
MCV>100micrometer3
MCH>33pg, but MCHC is Normal
Serum Fe is Normal or high TIBC is low


Iron requirement for normal pregnancy is 1gm
       - all woman of reproductive age should be given 400 mcg of folic acid daily
Curative
       - daily administration of Folic acid 4mg orally for at least 4 wks following delivery


Hb < 10gm%
Hypersegmentation of neutrophils
Megaloblast
MCV>100micrometer3
MCH>33pg, but MCHC is Normal
Serum Fe is Normal or high TIBC is low


Increase incidence of abortion, prematurity, IUGR and Fetal loss.
Perinatal mortality is high.
Incidence of pre-eclampsia, postpartum hemorrhage and infection is increased.


Careful antinatal supervasion
Air travelling in unpressurised aircraft to be avoided.
Prophylatically Folic A. 1gm daily.
Regular blood transfusion at approx. in 6 weeks interval