Anaemia in pregnancy

Question 1

What is the most common cause of anaemia in pregnancy?

Answer 1

Iron deficiency

Question 2

What are the less common causes of anaemia in pregnancy?

Answer 2

• Folic acid deficiency
• Sickle cell disease
• Haemoglobin sickle-C (HbSC).
• Beta thalassaemia (more common in patients from Southeast Asia, Southern Europe and Africa).
• B12 deficiency
• Chronic haemolysis (hereditary spherocytosis).
• Paroxysmal nocturnal haemoglobinuria.
• Leukaemia
• GI bleeding
• Coeliac disease
• Parasitic diseases (eg, hookworm, schistosomiasis)

Question 3

What is the pathophysiology of anaemia in pregnancy?

Answer 3

Increased iron requirements during pregnancy

Increase in plasma volume during pregnancy causes iron deficiency anaemia through dilution - i.e. the proportion of fluid in comparison to red blood cells increases.

Question 4

When are pregnant women screened for anaemia?

Answer 4

• the booking visit (often done at 8-10 weeks), and at
• 28 weeks

Question 5

What do laboratory investigations shown in anaemia?

Answer 5

• Hb low
• MCV low in Fe def; normal MCV with low Hb is usual in pregnancy
• Ferritin should be checked only if the patient has a haemoglobinopathy (treat if <30mcg/L)

Question 6

What cut-offs are used by NICE to determine whether oral iron therapy is required in pregnancy?

Answer 6

First trimester - < 110 g/L

Second/third trimester - < 105 g/L

Postpartum - < 100 g/L

Question 7

What is the management of anaemia in pregnancy?

Answer 7

100-200mg oral ferrous sulfate or ferrous fumarate - treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished

Refer to haematology in severe anaemia or if oral iron therapy is not effective.

Question 8

How do you manage an anaemic patient in labour?

Answer 8

Advise to deliver in labour ward

• IV access and group and screen on admission
• Active management of 3rd stage + of PPH
  
  • Consider prophylactic syntocinon infusion

Question 9

How do you manage postpartum anaemia?

Answer 9

Ideally measure at days 1-3

• If >7g/dl –> iron tablets
• If <7g/dl –> blood transfusion

Question 10

What is a complication of parvovirus B19 infection?

Answer 10

Maternal parvovirus infection is usually mild and occasionally sub-clinical.

In the fetus, however, it causes aplastic anaemia that in turn leads to high-output cardiac failure and fetal hydrops.

Question 11

How common is anaemia antenatally?

Answer 11

Occurs in ~25% of women antenatally and in a third postnatally

Question 12

What are the clinical features of anaemia?

Answer 12

• Fatigue
• Dyspnoea
• Dizziness

Question 13

What are the complication of anaemia in pregnancy?

Answer 13

• Maternal death.
• Fetal death.
• Premature delivery.
• Low birth-weight babies.
• Cardiac failure.
• Their babies having subsequent developmental problems.
• Poor work capacity/performance.
• Susceptibility to infection.