Anemia Flashcards
EB MFM, Creasy
Normal plasma iron level
40-175 mcg/dL
Normal plasma TIBC
216-400 mcg/dL
Normal transferrin saturation
16-60%
Normal serum ferritin level
> 10 mcg/dL
Definition of anemia in 1st or 3rd trimester
Hgb < 11 g/dL
Definition of anemia in 2nd trimester
Hgb < 10.5 g/dL
Physiologic changes in RBC mass and plasma in pregnancy
RBC mass and plasma both increase, but the plasma increase (50%) is proportionally greater than the RBC increase (15-30%)
Initial workup of anemia
CBC with Hgb and mean corpuscular volume
Workup if Hgb < 11 g/dL and MCV < 80 um3
Microcytic anemia
Obtain Hgb electophoresis and serum ferritin
Workup if Hgb < 11 g/dL and MCV > 80 um3
Retic count, history - active bleeding, med exposure, chronic dz, G6PD deficiency, fam hx of RBC disorders
Workup if high reticulocyte counts
Anemia may be due to hemolysis or blood loss
Consider:
Peripheral blood smear
Haptoglobin
Direct coombs for autoimmune hemolytic anemia
Electrophoresis
Hemoccult
Most common cause of anemia in pregnancy
Iron deficiency
Diagnosis of iron deficiency anemia
MCV < 80
Decreased serum iron
Increased TIBC (>400 mcg/dL)
Decreased serum ferritin (<30 mcg/L)
Complications of iron deficiency in anemia in pregnancy
Low birth weight Preterm birth Maternal CV compromise Need for transfusion Postpartum depression Poor mental and psychomotor performance testing in offspring
Dosing of IV iron sucrose
Weight before pregnancy (kg) x (110g/L - actual hemoglobin g/L) x 0.24 + 500 mg
Is anemia of chronic disease normocytic or microcytic?
Usually normocytic (20% microcytic)
Diagnosis of anemia of chronic disease
Decreased serum iron
Normal or increased serum ferritin
Decreased TIBC
Causes of anemia of chronic disease
Chronic liver disease Thyroid disease Uremia Chronic infections Malignancies
Workup of anemia of chronic disease
LFTs
BUN/Cr
TSH
Tests for malignancy or chronic infxn as indicated by hx/phys
Iron, B12, folate to rule out combine deficiencies
Iron studies in thalassemia
Normal or increased serum iron
Normal or increased TIBC
Common ancestries for alpha-thalassemia
Southeast Asian
Diagnosis of alpha-thalassemia
Probable alpha thal: MCV < 80 Nl Fe studies Hgb A2 on electrophoresis < 3.5% Confirm with DNA probe, consider testing of father/prenatal dx
Common ancestries for beta-thalassemia
Mediterranean Asian Middle Eastern Hispanic West Indian
Diagnosis of beta-thalassemia
MCV < 80
Nl Fe studies
Hgb A2 on electrophoresis >3.5%
Consider testing of father, prenatal dx if +, Hb electrophoresis at one year of age if negative
Recommended dietary allowance of ferrous iron during pregnancy
27 mg, present in most prenatal vitamins
Definition of macrocytic anemia
MCV > 100 fL
Causes of macrocytic anemia
Levels greater than 115 fL are almost exclusively seen in patients with folic acid or vitamin B12 deficiencies
Diagnosis of B12 deficiency
<100 pg/mL
Diagnosis of folate deficiency
RBC folate < 150 ng/mL
Causes of folate deficiency
Diets deficient in fresh leafy vegetables, legumes, or animal proteins.
Folic acid requirements in pregnancy
Increase from 50 mcg to 400 mcg per day
Treatment of pregnancy-induced folic acid deficiency
Nutritious diet, folic acid and iron supplementation
1 mg folic acid/day
Causes of vitamin B12 (cyanocobalamin) deficiency
Partial or total gastric resection, Crohn’s disease
Treatment of B12 deficiency
Monthly IM injections of 1000 mcg B12
