Anemia

Question 1

What lab values qualify as anemia in pregnancy?

Answer 1

• 1st/3rd tri: Hgb < 11g/dL
• 2nd: Hgb < 10.5g/dL
• Hct < 32%
• +/- MCV<80
• ferritin < 12*

Question 2

What is the best test for iron deficiency anemia?

Answer 2

iron studies: serum Fe level, total iron binding capacity, ferritin level

Question 3

What type of anemia is iron deficiency?

Answer 3

microcytic

Question 4

What are sx of anemia?

Answer 4

weakness, fatigue, dizziness, HA, SOB w/ exertion, restless leg syndrome, palpitations, irritability, pica

Question 5

What are risks associated w/ anemia?

Answer 5

• PTB
• LBW
• decreased mental and psychomotor performance
• decreased neonatal iron stores

Question 6

What boosts Fe absorption?

Answer 6

vitamin C (e.g. citrus); acid
take 30 mins before meals

Question 7

How should Fe levels be evaluated?

Answer 7

repeat CBC and serum ferritin in 4wks to evaluate response

Question 8

What are next steps if Fe levels do not improve?

Answer 8

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

Question 9

How much Fe do pts w/ deficiency require?

Answer 9

60-120mg elemental Fe supplementation

ex: 325mg ferrous sulfate has 60mg elemental iron

Question 10

How much Fe is required after Hgb returns to normal?

Answer 10

30mg/day for 4-6mo

Question 11

What are the indications for IV Fe?

Answer 11

• pt cannot tolerate PO Fe
• pt will not take PO Fe
• malabsorption
• severe anemia (but not enough for transfusion)

Question 12

How long does IV Fe take to have effect?

Answer 12

5 days to see change in Hgb

Question 13

What type of anemia is folate deficiency?

Answer 13

megaloblastic - impairment in RBC DNA –> macrocytosis

Question 14

What contributes to low folate in pregnancy?

Answer 14

• increased fetal demands

- decreased GI absorption

Question 15

What is the recommended dose of folate during pregnancy?

Answer 15

• 0.4mg PO qd

- 4mg PO w/ hx NTDs

Question 16

What are sx of folate deficiency anemia?

Answer 16

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

Question 17

What are the best tests for folate deficiency?

Answer 17

• serum folate = recently ingested folate

- RBC folate levels = best idea of folate status at tissue level

Question 18

What are risks of folate deficiency?

Answer 18

• anemia
• placental abruption
• pregnancy loss
• NTDs

Question 19

How is folate defiency treated?

Answer 19

5mg folate PO qd for 4mo or t/o pregnancy if underlying condition not corrected

Question 20

What are folate rich foods?

Answer 20

• dark leafy greens
• lentils
• beans
• peanuts
• fortified breads, cereals

Question 21

Which pts may require more folate supplementation?

Answer 21

• pts on rx w/ folate mechanism (e.g. antiepiletics)
• hemoglobinopathies
• multiple gestation
• short conception interval

Question 22

What foods are rich in B12?

Answer 22

• eggs
• milk
• milk products

Question 23

What type of anemia is sickle cell?

Answer 23

hemolytic (destructive) anemia
genetic hemoglobinopathy

• autosomal recessive (HbS instead of HbA)
• homozygous hemoglobin (HbSS)

Question 24

What occurs to RBCs in sickle cell anemia?

Answer 24

sickle under low 02 –> sludge in small vessels –> tissue infarction

Question 25

How is sickle cell anemia dx’ed?

Answer 25

hemoglobin electrophoresis - offer early in pregnancy

Question 26

What are risks associated w? sickle cell anemia?

Answer 26

• increased symptomology
• infection
• pulmonary complications
• PIH and preeclampsia
• FGR
• PTB

Question 27

What is recommended supplementation for pts w/ SCD?

Answer 27

• 5mg folic acid daily

- NO Fe supp unless documented IDA

Question 28

What are the odds of SCD and sickle cell trait for a baby whose parents are both carriers?

Answer 28

both parents have one HbS, one HbA –>

50% chance of SCT
25% chance of SCD

Question 29

Describe thalassemia patho

Answer 29

inherited, genetic hemoglobinopathy

4 genes make up alpha chain - mutations in any number = alpha thalasssemia

change from HbA to HbF = beta = most common

Question 30

Which pts should be screened for thalassemias?

Answer 30

• low MCV
• no evidence of Fe deficiency
• hypochromic, microcytic anemia

Question 31

What is minor thalassemia?

Answer 31

• MCH = 25-27
• microcytosis
• asymptomatic

Question 32

What is thalassemia intermedia?

Answer 32

• MCH < 25
• significant anemia
• may require transfusion

Question 33

What is thalassemia major?

Answer 33

• MCH < 25
• homozygous beta thalassemia
• transfusion dependent
• rarely become pregnant

Question 34

What are risks associated w/ thalassemia intermedia/major?

Answer 34

• cardiac failure
• alloimmunization
• viral infections
• thrombosis
• endocrine disorders
• bone disorders

refer to hematology and specialized care

Question 35

What foods are rich in Fe?

Answer 35

• 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

Question 36

What should be avoided w/ Fe supplementation (decreased absorption, side effects)?

Answer 36

• 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