Anaemia in pregnancy Flashcards
What is anaemia
A deficiency of HB in the blood
What percentage of pregnant women worldwide are affected by anaemia?
38%
What is anaemia defined as in each trimester?
Hb<110g/L in 1st trimester
Hb<105g/L in 2nd/3rd trimester
Hb<100g/L post partum
Describe how anaemia results in pregnancy
Haemodilution effect
During pregnancy both the plasma volume and red blood cell mass increase. Plasma volume increases disproportionately
List some risk factors for anaemia in pregnancy
Haemoglobinopathies - thalassaemia, sickle cell disease Increasing maternal age Low socioeconomic status Poor diet Anaemia during previous pregnancy
List the clinical features of anaemia
Asymptomatic
Dizziness
Fatigue
Dyspnoea
List some clinical signs on examination of anaemia
Pallor
Koilonychia
Angular cheilitis
List some causes of microcytic anaemia
Iron deficiency
Thalassaemia
Sideroblastic anaemia
List some causes of normocytic anaemia
Anaemia of chronic disease
Marrow infiltration
Haemolytic anaemia
Chronic kidney disease
List the causes of macrocytic anaemia
B12 deficiency Folate deficiency Alcohol consumption Reticulocytosis Hypothyroidism
What investigations do you do for anaemia
FBC - Hb and MCV
Serum ferritin - not routinely measured
Haemoglobinopathy screening should be considered in patients with confirmed anaemia and unknown haemoglobinopathy status
Serum folate
Haemoglobin electrophoresis
Sickle cell disease
When in the UK is anaemia screened for during pregnancy?
Booking and 28 weeks
Additional screening 20-28 weeks if multiple pregnancy
How is iron deficiency anaemia managed in pregnancy
Trial of oral iron (100- 200mg) - repeat FBC after 2 weeks
Parental iron infusion if compliance is poor or malabsorption
How is folate deficiency managed in pregnancy
Folate supplementation - 5mg folic acid OD - can be increased up to 3 times a day
How is beta thalassaemia managed during pregnancy
Folate supplementation and blood transfusions as required - aim for Hb 80g/L during pregnancy and 100g/L at delivery
