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 |
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
| | Iron | TIBC | Ferritin |
| Iron deficiency anemia | Decrease | Increase | Decrease |
| Anemia of chronic disease | Decrease | Decrease | Increase |
| Pregnancy | Increase | Increase | Normal |
|
| • | 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 |
