Anaemia in Pregnancy Flashcards
What is the definition of anaemia in pregnancy in each term?
Hb:
o < 110 g/L in 1st trimester
o < 105 g/L in 2nd/3rd trimester
o < 100 g/L postpartum
o < 70 g/L – URGENT REFERRAL
What is the prevalence of anaemia in pregnancy?
20%
What are the types of anaemia in pregnancy?
Iron
B12
Folate
Describe the 3 types of anaemia
o Iron deficiency – blood loss, inc. use, dec. absorption, dec. intake, haemolysis
§ Hypochromic microcytic anaemia, pencil cells
o Folate – green leafy vegetables -> lack increases neural tube defects – diet, demand, malabsorption, drugs
§ Megaloblastic anaemia (hypersegmented neutrophils, macrocytosis, thrombocytopaenia, leucopaenia)
o B12 – vegans, poultry, dairy, eggs -> lack increases neural tube defects – diet, malabsorption
§ Megaloblastic anaemia (hypersegmented neutrophils, macrocytosis, thrombocytopaenia, leucopaenia)
What are the risk factors for anaemia in pregnancy?
Multiple pregnancy
2 pregnancies close together
Lots of vomit due to morning sickness
Pregnant teenager
Anaemia before becoming pregnant
DIET (esp. iron deficiency)
What are the signs and symptoms of anaemia in pregnancy?
Tired or weak Dizziness SOB Trouble concentrating Tachycardia/Tachypnoea Pale skin, lips, nails, conjunctiva
B12-specific – glossitis, depression, psychosis/dementia, paraesthesia, peripheral neuropathy
SCDC = loss proprioception/vibration à full paralysis
When is anaemia screened for?
Booking
28 weeks
What investigations do you do for anaemia?
FBC
Blood film
Haematinics
Haematocrit
How do you manage anaemia in pregnancy?
Supplements
Dietary advice
Intra partum support
What supplements do you give??
iron, B12 and folate (i.e. 100-200mg OD iron -> recheck in 2-3 weeks)
§ I.E. Oral ferrous sulphate (note SEs: black stools, constipation, abdominal pain)
§ I.E. Oral folic acid (if cause not known, don’t give this as can exacerbate B12 symptoms)
§ I.E. IM hydroxycobalamin for B12 deficiency
What dietary advice do you give?
§ Iron – green leafy vegetables, nuts, beans, seeds
§ B12 – meat and dairy
§ Folate – green leafy vegetables, nuts, yeast, liver
What intra partum support would you give?
§ Deliver in consultant-led unit
§ IV access and group and screen on admission
§ Active management of 3rd stage
§ Active management of PPH
§ Consider prophylactic syntocinon infusion
What are the complications of anaemia in pregnancy?
o Preterm or LBW (Low Birth Weight) baby
o Postpartum depression
o Child with developmental delays
o Spina bifida
o Prognosis = good!
Describe the iron, TIBC and ferritin in IDA
Reduced iron, increased TIBC and reduced ferritin
Describe the iron, TIBC and ferritin in ACD
Reduced iron, reduced TIBC and increased ferritin
