Anaemia

Question 1

What is the definition of anaemia in pregnancy?

Answer 1

First trimester: Hb< 110g/L
Second/third trimester: Hb< 105g/L
Postpartum Hb<100g/L

Fall in Hb is steepest around 20 weeks and is physiological

Question 2

What are risks of anaemia in pregnancy?

Answer 2

PPH
Infection
Worsens heart failure
Perinatal problems associated with malaria

Question 3

What re prone to anaemia in pregnancy?

Answer 3

Those who start anaemic
Frequent pregnancies
Twin pregnancy
Poor diet

Question 4

What screening is there for anaemia?

Answer 4

Hb estimation at booking and at 28 weeks
Do sickle cell tests in black patients
Hb electrophoresis in others at risk for haemoglobinopathies

Question 5

What investigation should be done in anaemia?

Answer 5

FBC (MCV reduced)
Serum iron, serum ferritin low in iron deficiency
MCV is raised in folate deficiency

Question 6

What is the most common cause for anaemia in pregnancy?

Answer 6

Iron deficiency
Then folate

Also consider coeliac disease
CKD
Autoimmune disease

Question 7

What is treatment for anaemia in pregnancy?

Answer 7

Oral iron (ferrous sulphate) on alternate days or twice weekly 
(this may prevent GI side effects)

Parenteral iron may be given if not tolerating iron as iron dextran or iron sucrose
Beware anaphylaxis
Hb rises by 8g/L/week over 6 weeks so late severe anaemia may need transfusion
One U of blood increases Hb by 7g/L

Question 8

When is thalassaemia a risk?

Answer 8

Alpha thalassaemia as there are alpha chains in fetal HbF so fetus may be anaemic or stillborn

Risk of severe pre-eclampsia, delivery complications in mothers carrying hydropic foetuses that are affected