Anaemia in Pregnancy

Question 1

Definition

Answer 1

Low concentration of haemoglobin as a result of an underlying disease and is not a disease itself.

Question 2

Haemoglobin definition

Answer 2

Protein found in red blood cells. It is responsible for picking up oxygen in the lungs and transporting it to the cells of the body

Question 3

When are women screened for anaemia

Answer 3

Twice during pregnancy:
- Booking clinic
- 28 weeks gestation

Question 4

Pathophysiology

Answer 4

During pregnancy, the plasma volume increases. This results in a reduction in the haemoglobin concentration. The blood is diluted due to the higher plasma volume.

Question 5

Signs and symptoms

Answer 5

Can be Asx
- SOB
- Fatigue
- Dizziness
- Pallor

Question 6

Diagnosis

Answer 6

Normal ranges during pregnancy are:
- Booking bloods > 110 g/l
- 28 weeks gestation > 105 g/l
- Post partum > 100 g/l

Question 7

What does the MCV indicate?

Answer 7

The cause of anaemia:
- Low MCV = iron
- Normal MCV = physiological anaemia due to the increased plasma volume of pregnancy
- Raised MCV = B12 or folate deficiency

Question 8

Treatment

Answer 8

Ferrous sulphate 200mg three times daily
- When Px not anaemic but have low ferritin = (indicating low iron stores) = started on supplementary iron.

Question 9

B12 Tx

Answer 9

Tested for pernicious anaemia (checking for intrinsic factor antibodies).
- Intramuscular hydroxocobalamin injections
- Oral cyanocobalamin tablets

Question 10

Folate Tx

Answer 10

All women should already be taking folic acid 400mcg per day. Women with folate deficiency are started on folic acid 5mg daily.

Question 11

Thalassaemia and sickle cell anaemia

Answer 11

Px with a haemoglobinopathy will be managed jointly with a specialist haematologist. They require high dose folic acid (5mg), close monitoring and transfusions when required.