Anaemia Flashcards
Parameter for anaemia in pregnants?
<11.0g/dL in 1st trimester
<10.5g/dL in 2nd trimester
<10g/dL in 3rd trimester
Cause of physiologic anaemia in pregnanc?Y
- Total intravascular volume expands 50% near term
- Total RBC mass rises 25%
- greater expansion in plasma causes physiologic anaemia
risks of anemia in pregnancy?
Risk of maternal mortality x3-5
Risk of stillbirth x6
Maternal = peripartum bleeding, high risk of infection, post-partum depression
Fetal = preterm delivery, low birthweight, perinatal mortality, reduced brain maturation
Most accurate way to measure iron levels?
Ferritin levels. <15mcg/L
Iron supplementation for anaemic pregnants?
Oral supp recco if Hb >6.5 before 36 weeks
Max daily dose is 200mg elemental iron to avoid GI upset
Avoid milk, caffeine, tea. Fruit juice with ascorbic acid raises absorption.
Indication for parenteral iron?
Intolerance to oral iron
Malabsorption
Anaemia diagnosed after 36 weeks
Hb <6.5g/dL
Contraindicated in 1st trimester
When to suspect thalassemia?
When low MCV <80fl + low Hb
Normal iron and ferritin level
How to diagnose thalassemia
Hb electrophoresis
Molecular diagnostic tests
Commoner in Asians
Types of thalassemia?
Alpha thal minima = asymptomatic, no anemia
Alpha thal minor = mild anemia
Hemoglobin H disease = moderate hemolytic anemia
Hydrops fetalis with Hb Barts = cannot live outside uterus
Types of Beta Thalassemia?
Beta thal minor = asymptomatic, mild anemia
Beta thal intermedia
Beta thal major = severe hemolytic anemia, jaundice, hepatosplenomegaly, growth impairment, lifelong transfusion dependent
Risk factors for B12 / folate deficiency?
Vegetarian
Bariatric surgery patients
Coeliac disease
IBD
What happens in pernicious anemia?
autoantibody interferes with absorption of B12
