ANAEMIA IN PREGNANCY

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INTRODUCTION:

• Anaemia is the commonest medical disorder in pregnancy

• It is responsible for 40-60% of maternal deaths

• It causes direct & indirect deaths;CHD,H-ge,Infection,PE

• It increases PNM;PTL,IUGR, low iron stores & iron def. anaemia.

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Factors required for erythropoiesis:

• Proteins ; Erythropoietin• Minerals; Iron• Trace elements; Zinc,cobalt• Vitamins;Folic acid,B1+6+12,C• Hormones;Androgenes & T4• Also;Vit A(cell growth),Zinc-needed

for protein synthesis

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DEFINITION:• A condition of low Hb,lying at two

standard deviations below the median of a healthy population of the same age,sex and stage of pregnancy.

• Cut-off ; for WHO= < 11g/dl and PCV < 0.33. For USA= < 10.5g/dl, during the second trimester

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SEVERITY OF ANAEMIA

CATEGORY SEVERITY Hb lev.(g/dl)

I Mild 10.0-10.9

II Moderate 7.0-10.0

III Severe < 7.0

IV V.severe(de compensat.)

< 4.0

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Prevalence of Anaemia:

• Globally = 40%• It is <20% in Europe up to >80% in the Indian

sub-continent.• IDA is the commonest type• The balance between the iron ingested and

lost dictates the iron nutritional status!• Food iron =provide 6mg/1000 calories• There are Haem & non-haem pools;• Haem absorption = 15-50%,not affected by

inhibitors. Non-haem absorption-- is increased by enhancers & decreased by inhibitors.

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Classification:

1. Iron deficiency2. Megaloblastic–folic acid, vita B12

( uncommon)3. Haemolytic(infection, malaria)4. Haemoglobinpathies; Sickle-cell,

Thalathaemias.5. Aplastic

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• Factors affecting the Iron statusIRON ABSORPTION IRON LOSS

Enhancers:Haem iron, proteins, meat,vit C, alcohol fermentation, gastric acidity,ferrous iron, low iron stores, high altitude,haemolysis.Inhibitors:Phytates, calcium, tannins, tea & coffee, herbal drinks, iron fortification.

Physiological :Losses from skin and intestines, delivery, lactation, menses.

Pathological :Hookworm and othersH-ge from GITAllergiesOccult blood losses.

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Iron bio-availability:• I] Low ; simple,routine diet of

cereals,maize,rice,beans etc. + negligable amounts of meat,fish and vit C.low absorption[3-4%].

• II] Intermediate ; include some animal foods.• III] High ; rich in animal foods + generous

amount of vit C. IRON REQUIREMENTS : Vary with maternal body weight and the

maturity of the fetus; 2.5 mg/d in early pgy,5.5mg/d in 20-32/52,6-8mg/d from 32/52 Absorption < 10%; so iron suppl.is needed. www.doctor.sd

Investigations:

• Aims: at finding; Degree, Type and Cause of anaemia.

• Hb, Red cell count, PCV.• Peripheral blood smear ; Micro-, Aniso-, and

Poikilocytosis.• Haem Indices; MCHC--most sensitive.• Anaemia: Hb<10gm%,RedCC< 4mln/mm³ PCV< 30%,MCH< 30%,MCV< 75µm³, and

MCH< 25pg.• Others: Serum Fe< 30µg%, TIBC> 400µg%,

Saturation< 10%,Ferritin< 15µg/L. Stools, Urine, Bone marrow study (not routinely).

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CAUSES OF IRON DEFICIENCY:

1.Diet; habits, poverty, food fadism = when some types of food is not allowed due to customs !

2.Worm infestation; Amoebiasis and Giardiasis. Shistosomiasis.Malaria. Excessive sweating and piles.

3.Multiple pregnancies.

PREVENTION:1.Prophylaxis of non-pregnants; giving them 60mg of iron daily for

2-4/12.2.Iron supplementation during pgy ; WHO--- 60mg Fe + 250µg Folic acid 1-2/day, 2-3 inj. Of Imferon 250mg IM monthly.3.Trt of hookworms; Albendazole 400mg/d or Mebendazole 100mg

twice/d for 3 days.4.Improvement of dietary habits.5.Social services; education, personal hygiene , sanitation and alleviation of poverty.6.Food fortification; of fish sauce,sugar,curry powder & salt with ferrous sulphate,gluconate,fumarate or succinate or chelated

iron [bovine Hb concentrate and Fe-Na-EDTA]. www.doctor.sd

TREATMENT

• Accurate diagnosis of anaemia.• Admission: 1)Hb<7gm%.2)Other associated

medical condition.• Choice of therapy depends on: a)Severity. b)

Duration of pgy. c) Associated factors.• Options:1)Oral Fe.2)Parentral. 3)Blood

transfusion.• TDI & Exchange blood transfusion to be used

in certain circumstances.• Expected rise of Hb is 0.7-1gm/week.• Folic acid is added in most cases. Anti-- biotics

& Anti-helminthics may also needed

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