Anaemia And Haemoglobinopathies Flashcards
What are the 6 types of anemia
Iron deficiency
Folate deficiency
B12 defiency
Inheritses haemolytic
Acquired haemolytic
Thalasseamia
What is inherited haemolytic
Inherited blood condition that occurs when your red blood cells are destroyed faster than they can be replaced
Acquired haemolytic anaemia
Developed condition
Thalasseamia
Inherited conditions that affect haemoglobin
What is anaemia
Condition where the number size or hb content of RBC is decreased
Definition of anaemia in pregnancy
Iron defiency anaemia - low serum ferritin conc of more less than 30ug/L
Haemoglobin of
less than 110 1st trimester
Less than 105 2nd and 3rd
Less than 100g postpartum
Anaemi is treated when accompanied by depleted iron sores plus signs of a comprimesed supply of iron to the tissues
Prevalence of anaemia i 2019
Globally Pregnant women- 36.5%
Globally Children - 39.8
African countries - children 60.2%
Balance of iron stores
Iron is saved in pregnancy through increased absorption, moblistaionof iron stores and lack of menses
Vs
Iron is lost sure to additional iron requirements for increase in erythrocytes stored in the placenta and fetal needs in pregnancy
Iron lost as birth but is required for lactation
Total mean iron requirement of pregnancy
1000-1310mg
What is the mean iron requirement due to
Increase in maternal red cell mass 500mg
Foetus 300mg
Placenta 35-100mg
Insensible ls through urine stools and skin 200mg
When do most iron requirements occur
In the lat 20/40 averaging 6-7mg per day
Placenta will ensure iron gets to the foetus despite maternal levels
What is mean cell volume
Are mean vol of a red cell fluctuates in non- preganant rangee 77-79 femolitres
Sensitive measurement of iron status in pregnancy
What happens in normal pregnancy in red cell size
Increases
Wat happens tto red cells size with true iron deficiency anaemia
Reduced
Mean cell haemoglobin
Average amount of hb in red cell fall with non pregnant range of 26-32 picograms
Indicates how well filled the cells are with Hb and falls within the normal on pregnant range of 32- 360g/L
No real change in pregnancy
Packed cell volume
Aka Hct haematocrit
Falls from 0.45-0.33L/L (45%-33%)
What happens to ferrotin levels in pregnancy
Fall
90 macrograms/L 1st trimester
30macrograms/L 2nd trimester Less than
15 macrograms/L 3rd trimester
What happens to maternal circulating plasma volume
Increase up to 50% by 32-34/40 a likely total increase of 1200ml by term
Physiological anaemia
Why does RBC increase by 18-25%
Due to 3 fold rise in erythropoietin in 2nd trimester due to progesterone prolactin and human placental lactogen influences
Conc of RBC reduces from 4.2x10^12 to 3.8x10^12/L by term
Physiological anaemia
What does Rise in plasma % compared to RBC % rise causes
haemodilution in pregnancy
This causes a fall in Hb concentration, reaches a nadir in. 2nd trimester (when plasma expansion as its greatest and rises in 3rd
This is not pathological and does not require treatment or supplementation
Hb may drop 2g/L in pregnancy
Treatment of serial Hb less than 100g/L r progressive reduction of MCV should be treated
What percentage if the rich world women have true iron defiency anaemia
2%
What % poor world women have true iron defiency
Up to 50% contributing to High mortality rates
Iron defiency anaemia + folic acid + vitB12 deficiencies
General causes of iron defieicny anaemia
Inadequate intake of iron - diet
Poor absorption of iron - malabsorption
Loss of iron due to parasitic infections
Blood loss
Diseases such as colitis
Certain medications (ranitidine, omeprazole)
Which women should we identify at risk at booking history
Reduced food intake malnutrition
Excessively heavy menstruation
Short pregnancy gap
Previous APH/PPH
Multiple pregnancies
Low socioeconomic groups
Inherited haemoglopbinopathies
Causes of anaemia in pregnancy
Ruptured ectopic pregnancy
APH
PPH
Ion deprivation from pregnancy - heavy menstrual flow
Amoebic dysentery
Malaria
Clostridium Welch’s causing haemolysisi
Hook worm
Bilharzia
Dietary defiency of iron
Excess demands - multiple pregnancy
Chronic inflammation - recent UTIs/ chronic kidney disease
Threatened and spontaneous miscarriage
Bleeding haemorrhoids
Haemoglobinopathies (sickle cell, Thalasseamia)
Signs and symptoms of anaemia
Fatigue
Giddiness
Palpitations
Shortness of breath
Tachycardia
Pallor
Pale mucous membranes
Loss of appetite
Feeling cold
Pica
Oedema
Effects of anaemia on pregnancy
Lowered immunity
Increased risk of infection
APH/PPH risk increased
Increased risk of postnatal depression
Effect of anaemia on fetus/baby
Intrauterine hypoxia
Intrauterine growth restriction
Low birth weight
Pre them labour
Or iron stores in 1st year of life
Poor cognitive performance
Management of iron defiency anaemia
Diet
Oral iron supplementation
Paternteral iron supplementation
Delayed cord clamping at delivery
Management diet
Haem iron - red meat, fish,poultry are all generally well absorbed
Non haem iron - cereals pulses legumes dark leaf veg dried fruit
Fortified cereals
Fruit and veg rich in vit C that absorb iron - kiwis orange juice potatoes cauliflower broccoli
What foods inhibit absorption of iron absorption
Milk
Eggs
Tea
Coffee
Ran
Oats
Corn
What are the issues with diet management
Affordability
Lifestyle changes
Vegetarian diet
Iron defiency anaemia supplements
Ferrous sulphate tablets can be taken up to tds \iron content - 68mg per tablet
Ferrous glauconite - 300mg tablet contains 35,g iron
Ferrous fumarate - 322mg UHL guideline check hb after 2/40
How can you increase iron absorption
Maximise with orange juice
Vit c ascorbic acid
Unwanted effect nausea abdominal pain vomiting constipation black stools
Issues for iron supplement
Accidentally swallowed by children
Better tolerated preparation are expensive
Benefits for those who can afford them - pregnacare
Parental iron infusion
In 2nd trimester less than 34/40 or postpartum if intolerant non compliant fail to respond to oral iron or proven malabsorption
IM no longer used
Intravenous iron
High risk of hypersentiviy anaphalytic shock
Mandatory test dose - need cpr facilities
Does depend on women weight and Hb
Contr indications
H/o anaphalixis
Chronic infection
Chronic liver disease
Requires strict monitoring and ECG as can cause SVTs
What complications can anaemia bring I’d not treated
Low birthweight
Premature labour and birth
Stillbirth
Higher risk of needing a blood transfusion in labour
Reduced breast milk or chest milk supply
Iron defiency i the first 33 months of your babys life
Fatigue in the few months after birth
Postnatal depression
How will iron deficiency affect women and baby
Low birthweight
Premature birth and labour
Stillbirth
Higher risk of needing blood transfusion
Reduced breast milk upply
Iron def in first 3months of your babys life
Fatigue
Postnatal depression
Investigations for anaemia
Diet
Lifestyle
Blood test
Hb levels
MCV
PCV
Serum ferritin
Folate defiency anaemia
Folate essential for dna synthesis and cell duplication
3x increase in demand in pregnancy
Folate stores only last of few weeks
When depleted there is a elated maturation of the red blood cell in the nucleus in the bone marrow
Red blood cells ar mis shapen and reduced survival time
What is folate defiency anaemia caused by
Poor diet - common in alcoholics
Malabsorption syndromes
Drugs
Uk incidence - 0.5%
Globally 1/3 pregnancies
Clinical signs and symptoms for folate defiency
Extreme tiredness
Pins and needles
Muscle weakness
Depression
Associated risks of folate defiency
Miscarriage
APH
Preterm labour
Neural tube defects
What are good sources 0f folate
Broccoli
Sprouts
Peas
Asparagus
Small mount in leafy green veg
Folate defiency anaemia intake
Recommend intake -50 dietary folate equivalent daily rises to 400 by day in pregnancy
5000 macrograms of folic acid for women with previously had a baby with a neural tube defect , taking meds for epilepsy, have diabetes or colleic disease
Family history of neural tube defect should take a higher dose
Pernicious anaemia
Vit b12 defiency
Helps form myelin
Produce energy from metabolism of fat and protein
Produce hb
Vit b12 bound to protein in food
Hydrochloric acid in stomach releases b12 from proteins during digestion
PNE released vitamin b12 combines with gastric intrinsic factor
The complex can then be absorbed by intestinal tract
Signs and symptoms of pernicious anaemia
Yellow tinge to skin
Sore and red tongue
Mouth ulcers
Pins and needles
Disturbed vision
Irritability
Decline in mental abilities
Sources of vit b12
Beef liver
Salmon
Cod
Eggs
Cheese
Treatments
Injections of vitb12
Life long treatment every 3months
Management of Thalasseamia
Preconcptual care
Full blood count - HB and MCV
Bone marrow
Erlly pregnancy test - CVS
Antenatal care
Regular Hb and serum ferritin levels
Risk of preterm labour
Hypoxia of mother and fetus
Management of Thalasseamia in labour
Script monitoring of FH
By
Fluid balance
Active management of 3rd stage
Management of Thalasseamia in postnatally
Observe for signs of infection and haemorrhage
Anaemia
Paediatric follow up
Ongoing
Periodic blood transfusion
Symptoms of sickle cell crisis
Pain
Breathlessness
Pallor
Fever
General weakness
Vision problem
Triggers of sickle cell crisis
Infection
Cold temp
Dehydration
Stress
Exercise
Complications of sickle Cell crisis
Chronic anaemia
Bone marrow suppression
Thromboembolic disease - blood clots
Cardiac failure
Sudden death
Management of sickle cell
Pre conceptual - folic acid 5mg/day
Antenatal - booking med history
Obs/haem team
Investigations- FBC, blood group, antibody,ferritin, hiv, renal and liver function and reticulocyte count.
Aspirin
Antibiotics
If mothers ar admitted - sickle cell
Low molecular weight heparin
Vt d
By
O2 stats
Asymptotic infection
Acute chest symptoms 7-20%
3rd trimester - serial growth/doppler
In labour there is a risk of sickle crisis
Avoid prolonged labour
Postnatal - risk of sickle crisis, PPH and dvt
Neonatal screening - birth follow up electrophoresis 6 weeks to screen for Thalasseamia/ antibiotic from 3 months
