Anemia Flashcards
What lab values qualify as anemia in pregnancy?
- 1st/3rd tri: Hgb < 11g/dL
- 2nd: Hgb < 10.5g/dL
- Hct < 32%
- +/- MCV<80
- ferritin < 12*
What is the best test for iron deficiency anemia?
iron studies: serum Fe level, total iron binding capacity, ferritin level
What type of anemia is iron deficiency?
microcytic
What are sx of anemia?
weakness, fatigue, dizziness, HA, SOB w/ exertion, restless leg syndrome, palpitations, irritability, pica
What are risks associated w/ anemia?
- PTB
- LBW
- decreased mental and psychomotor performance
- decreased neonatal iron stores
What boosts Fe absorption?
vitamin C (e.g. citrus); acid take 30 mins before meals
How should Fe levels be evaluated?
repeat CBC and serum ferritin in 4wks to evaluate response
What are next steps if Fe levels do not improve?
look for blood loss or parasites
- stool tests for occult blood, ova/parasites
- if reticulocyte count does not improve w/ tx, pt may have folic acid deficiency
How much Fe do pts w/ deficiency require?
60-120mg elemental Fe supplementation
ex: 325mg ferrous sulfate has 60mg elemental iron
How much Fe is required after Hgb returns to normal?
30mg/day for 4-6mo
What are the indications for IV Fe?
- pt cannot tolerate PO Fe
- pt will not take PO Fe
- malabsorption
- severe anemia (but not enough for transfusion)
How long does IV Fe take to have effect?
5 days to see change in Hgb
What type of anemia is folate deficiency?
megaloblastic - impairment in RBC DNA –> macrocytosis
What contributes to low folate in pregnancy?
- increased fetal demands
- decreased GI absorption
What is the recommended dose of folate during pregnancy?
- 0.4mg PO qd
- 4mg PO w/ hx NTDs
What are sx of folate deficiency anemia?
sx of anemia +
- hypopigmentation
- low grade fever
- neuro sx (e.g. numbness, tingling, decreased mental alertness, memory problems)
*sx may also be seen in B12 deficiency - check B12 levels prior to folate supps
What are the best tests for folate deficiency?
- serum folate = recently ingested folate
- RBC folate levels = best idea of folate status at tissue level
What are risks of folate deficiency?
- anemia
- placental abruption
- pregnancy loss
- NTDs
How is folate defiency treated?
5mg folate PO qd for 4mo or t/o pregnancy if underlying condition not corrected
What are folate rich foods?
- dark leafy greens
- lentils
- beans
- peanuts
- fortified breads, cereals
Which pts may require more folate supplementation?
- pts on rx w/ folate mechanism (e.g. antiepiletics)
- hemoglobinopathies
- multiple gestation
- short conception interval
What foods are rich in B12?
- eggs
- milk
- milk products
What type of anemia is sickle cell?
hemolytic (destructive) anemia
genetic hemoglobinopathy
- autosomal recessive (HbS instead of HbA)
- homozygous hemoglobin (HbSS)
What occurs to RBCs in sickle cell anemia?
sickle under low 02 –> sludge in small vessels –> tissue infarction
How is sickle cell anemia dx’ed?
hemoglobin electrophoresis - offer early in pregnancy
What are risks associated w? sickle cell anemia?
- increased symptomology
- infection
- pulmonary complications
- PIH and preeclampsia
- FGR
- PTB
What is recommended supplementation for pts w/ SCD?
- 5mg folic acid daily
- NO Fe supp unless documented IDA
What are the odds of SCD and sickle cell trait for a baby whose parents are both carriers?
both parents have one HbS, one HbA –>
50% chance of SCT
25% chance of SCD
Describe thalassemia patho
inherited, genetic hemoglobinopathy
4 genes make up alpha chain - mutations in any number = alpha thalasssemia
change from HbA to HbF = beta = most common
Which pts should be screened for thalassemias?
- low MCV
- no evidence of Fe deficiency
- hypochromic, microcytic anemia
What is minor thalassemia?
- MCH = 25-27
- microcytosis
- asymptomatic
What is thalassemia intermedia?
- MCH < 25
- significant anemia
- may require transfusion
What is thalassemia major?
- MCH < 25
- homozygous beta thalassemia
- transfusion dependent
- rarely become pregnant
What are risks associated w/ thalassemia intermedia/major?
- cardiac failure
- alloimmunization
- viral infections
- thrombosis
- endocrine disorders
- bone disorders
refer to hematology and specialized care
What foods are rich in Fe?
- heme sources (e.g. oysters, beef, turky, dark meat, fish)
- nonheme sources (e.g. 100% fortified cereals, oatmeal, soybeans, lentils, beans)
- organ meats (e.g. liver) *not recommended in pregnancy
What should be avoided w/ Fe supplementation (decreased absorption, side effects)?
- taking on empty stomach –> GI effects (e.g. nausea, dyspepsia, constipation, diarrhea)
DECREASED ABSORPTION
- antacids
- chronic use of H2 blockers and PPIs
- coffee, tea, carbonated beverages; avoid at meal times
