Muhammad Noman Roll no 07_107 Batch “L”

ANAEMIA IN

PREGNANCY

CONTENTS DEFINITION TYPES OF ANEMIA IRON DEFICIENCY ANEMIA CAUSES CLINICAL PICTURE DIAGNOSIS TREATMENT OTHER TYPES OF ANEMIA INVESTIGATION PROTOCOL OF ANAEMIC

PATIENT

ANEMIA A REDUCTION BELOW NORMAL LIMITS OF TOTAL CIRCULATING RED CELL MASS ANEMIA IN PREGNANCY

NORMAL PHYSIOLOGICAL CHANGES A) PLASMA VOLUME….40-50% B) RED CELL MASS……18%

HAEMDILUTION OR DILUTIONAL ANEMIA

WHO DEFINITION

Hb. concentration < 11g/dl

Haematocrit < 33%

MILD 10-10.9g/dl

MODERATE 7-10g/dl

SEVERE <7 g/dl

VERY SEVERE <4 g/dl

TYPES OF ANEMIA IN PREGNANCYCOMMON TYPES Nutritional Deficiency Anemias 1) Iron deficiency 2) Folic acid deficiency 3) Vit B12 deficiency Haemoglobinopathies 1) Thalassaemia 2) Sickle cell disorderRARE TYPES Aplastic anemia Autoimmune hemolytic anemia

IRON DEFICIENCY ANEMIA

INTERNAL IRON CYCLE

IRON ABSORPTION early pregnancy 4mg 6.6mg avg diet 14mg 1-2mg absorbed

INCR. IRON DEMAND 700-1400mg with avg of 1000mg fetus and placenta…500mg red cell expansion….500mg 1360mg loss at delivery ……..180mg lactation ……180mg

amenorhea during lactation saves 360 mg’\ AVG TOTALT INCR IN IRON DEMAND= 1360-360=1000MG

On avg full iron stores(liver,spleen and bone marrow) contain 750-1000mg of iron

CAUSES• 1)DIETARY LACK

Poverty Nutritional deficiency Food faddism Hyperemesis

• 2)IMPAIRED ABSORPTION Worm infestations Amebiasis Giardiasis Inhibitors

• 3)INCREASED LOSS A)GIT Peptic ulcer gastric/ colonic Ca Hemorrhoids Hookworm infestation Schistosomiasis Chronic malariaB)URINARY TRACT Renal, Pelvic Or Bladder tumorsC) GENITAL TRACT Repeated pregnancies Menorrhagia Utrine CA

IRON DEFICIENCY ANEMIA

EFFECTS OF ANEMIA MATERNAL EFFECTS

High output cardiac failure Haemorrhage Infections Preeclampsia Maternal mortality

FETAL EFFECTS LBW babies Preterm Cognitive and effective dysfunction

CLINICAL PICTURE MODERATE

SYMPTOMS Incr. weakness easy fatiguibility MILD indigestion

Asymptomatic loss of apetite

SEVERE

Palpitaions Severe Breathlessness Cardiac failure

SIGNS pallor systolic murmur gen. body oedema

DIAGNOSIS

Serum ferritin(pg/l)

15-300 <10

Normal non pregnant

Normal pregnant

Fe deficiency anemia in pregnancy

Hb(g/dl) 12-14 11-12.5 <11

Hematocrit(%) 37-45 33-38 <33

MCHC 32-36 32-36 <32

MCV(cubic microns)

80-100 70-90 <70

MCH(pg/cell) 27-34 23-31 <23

Serum Fe(microg/dl)

13-27 <13

TIBC(%) 33 <15

transferrin saturation(%)

25-35 15-30 <15

PERIPHERAL BLOOD FILM

BONE MARROW EXAMINATION

OTHER INVEST -Stool examination -malarial parasite -urine examination

IRON DEFICIENCY ANEMIA

TREATMENT OBJECTIVES -Normal Hb levels by last month of pregnancy

-To replenish the iron stores

(1) IRON THERAPY (2) BLOOD TRANSFUSION WHAT TO CHOOSE???

IRON THERAPY

(1) ORAL IRON

PREPARATIONS

- Ferrous sulphate(20%)

Ferrous fumarate(30%)

(2) PARENTRAL IRON PREPARTIONS Fe Sorbitol (I/M) Fe Sucrose (I/V)

INTRAVENOUS ROUTE 1) Fe sucrose complex (VENOFER) 5-10ml aliquots upto 3 weeks 2)Total dose Fe dextran

INTRAMUSCULAR ROUTE Fe sorbitol citrate (JACTOFER)

RESPONSE With in 2-3weeks

Poor response

-Inaccurate diagnosis

-Non compliance

-Continued blood loss

-Coexisting infections

-Concommitant folate deficiency

BLOOD TRANSFUSION

INDICATIONS Anemia beyond 36 weeks Anemia severe OR mild-moderte that fails to respond Excessive haemorrhagePACKED CELLSEXCHANGE TRANSFUSION

TREATMENT OF OTHER PROBLEMSWORM INFESTATIONS Albendazole 400mg Mebendazole 100mg daily for 3 daysMALARIAUTIBLEEDIND HAEMORRHOIDS

PROPHYLAXISA) PREPREGNANCY ERA Fe suplement 60mg/d for 2-4 months Fortification

B)DURING PREGNANCYFe suplements With normal iron stores 30-60mg/d With empty iron stores 120-240mg/d

6months during pregnancy and 3 months post partum

Treatment of infections

Dietary advise Food rich in iron

Cook food in iron utensils

Inhibitors of absorption avoid too much cooking

INVESTIGATION PROTOCOL OF ANAEMIC PATIENT High MCV

(>99fl)

Normal MCV(75-99fl)

Low MCV(<75FL)

ANAEMIA(Hb<11g/dl)

Dec s. ferritin

Dec TIBC

Fe studies

>3.5%

HbA2 levels

Normal

Alfa thalassaemiaBeta thalassemia minor

Family studies

Normal(1.5-3.5%)

Abn. RBC morphology

Retics>2-3%

ReticulocyteCount

Normal or low

Reticulocytecount

Haemolysis

Normal RBC morphology

folate<3.4microg/lB12<20microg/lHypersegmented

neutrophils

Folate levelB12 level

(peripheral smear)

HaemoglobinopathiesOther types of hemolytic anaemia

Drugs autoimmuneG6PD deficiency

DrugsChr diseaseMild Fe def

Folate or b12 def

bleeding

Fe deficiency

Thank you