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Perinatal Medicine > Anaemia in pregnancy > Flashcards

Anaemia in pregnancy Flashcards

1
Q

What is the WHO definition of anaemia in pregnancy?

A

Hb of < 11g/dl

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2
Q

What physiological changes in pregnancy can contribute to anaemia?

A
  • Increase in maternal plasma volume by up to 50% (peak of haemodilution at 32 weeks)
  • Iron stores utilised by fetus
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3
Q

What are the 3 major mechanisms of developing anaemia?

A
  1. Decreased intake or absorption
  2. Depressed production
  3. Increased demand or loss
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4
Q

What is the most common cause of anaemia?

A

Iron deficiency

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5
Q

List 6 causes of anaemia

A
  1. Iron deficiency
  2. Folate deficiency
  3. Vitamin B12 deficiency
  4. Haemoglobinopathies (e.g. thalassaemia, sickle-cell disease)
  5. Haemolytic anaemia
  6. Bone marrow aplasia
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6
Q

Major mechanisms of iron deficiency anaemia in pregnancy?

A
  • Expansion of maternal red cell mass

- Use of iron stores by fetus and placenta

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7
Q

Daily iron requirements in females of reproductive age?

A

2mg/day

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8
Q

Daily iron requirements in early pregnancy?

A

4mg/day

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9
Q

Daily iron requirements in late pregnancy (32 weeks)?

A

6-8mg/day

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10
Q

Which dietary group are at particular risk of developing an iron deficiency anaemia and why?

A

Vegans. Haem iron, derived from meat, is more readily absorbed than non-haem iron

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11
Q

How much blood loss can be tolerated on average without a drop in Hb level?

A

1000ml

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12
Q

Why is decreased MCV of RBCs following a microcytic anaemia often not obvious in pregnancy?

A

Decreased MCV may be masked by the relatively large proportion of young, large RBCs (increased erythropoeisis)

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13
Q
  • What is the earliest abnormal laboratory test in iron deficiency anaemia in pregnancy?
  • What does this test reflect?
  • What aspect of the test bolsters it’s reliability?
A
  • Serum ferritin levels.
  • Is an indirect reflection of total body iron stores.
  • It is not affected by recent ingestion of iron, thus giving a reliable long-term representation of iron levels
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14
Q
  • What is the most reliable method of diagnosing iron deficiency anaemia in pregnancy?
  • Why isn’t this done often?
  • When is it done?
A
  • Bone marrow biopsy to measure iron levels there
  • Highly invasive technique
  • Used when non-invasive tests are not conclusive and a differential is crucial
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15
Q

Management of iron deficiency anaemia of pregnancy

A
  • Identify and treat underlying cause e.g. diet, infection
  • Look for and treat associated infections e.g. UTI, GIT parasites
  • Oral iron supplements (ferrous sulphate) –> NB adherence
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16
Q

When is blood transfusion for anaemia considered?

A
  • Very severe anaemia

- Especially considered in women who are near to term (36 weeks+)

17
Q

How to prevent iron deficiency anaemia

A

All antenatal patients should receive 200mg ferrous sulphate orally, daily

18
Q

Why is folate an essential micronutrient?

A

Required for cell growth and division (essential for DNA and amino acid synthesis through THF production)

19
Q

Potential consequences of folate deficiency for the mother?

A
  • Megaloblastic anaemia
  • Glossitis
  • Diarrhoea
  • Depression
20
Q

Factors which increase the risk of folate deficiency anaemia?

A
  • Multiple pregnancy
  • Excessive alcohol consumption
  • Anti-convulsant medications, and other folate antagonists
  • Grand multiparity with short intervals between pregnancies
21
Q

Main aspects of laboratory diagnosis of folate deficiency anaemia?

A
  • Macrocytosis
  • On peripheral smear: oval macrocytes; hypersegmented neutrophil nuclei
  • Low reticulocyte count
  • RBC folate levels more accurate measure than serum levels
22
Q

Alterations in laboratory parameters in iron deficiency anaemia?

A
  • Decreased Hb (relatively late development)
  • Microcytosis (may be masked by erythropoeisis)
  • Decreased MCH
  • Decreased MCHC
  • Increased total iron-binding capacity
  • Decreased serum ferritin
  • Increased zinc protoporphyrin (= Hb with zinc in centre of molecule, rather than iron)
  • Increased transferring receptor levels
  • Decreased bone marrow iron levels
23
Q

Management of folate deficiency anaemia in pregnancy?

A

Oral folic acid supplements (5mg daily)

24
Q

Risk factors for Vitamin B12 deficiency anaemia in pregnancy?

A
  • Vit B12 deficiency very rarely causes megaloblastic anaemia in pregnancy
  • Dietary deficiency possible in strict vegans
  • Decreased absorption in patients with pernicious anaemia or following gastric resection
25
Q

Management of Vitamin B12 deficiency in pregnancy

A
  • Recommended intake 3ug/day in pregnancy
  • Empiric therapy usually given if this diagnosis is suspected [neuro findings e.g. numbness, paraethesia, ataxia, altered mental state]
  • Parenteral route (GIT absorption often the cause)
26
Q

Dr Jansen’s causes of anaemia in pregnancy (9)

A
  • Dilutional effect (physiological)
  • Iron deficiency
  • Blood loss
  • Haemolysis
  • Folate/B12 deficiency
  • Chronic disease
  • Infection (e.g. malaria)
  • Haemoglobinopathy
  • Cancers

Perinatal Medicine (14 decks)

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