Anemia in pregnancy Flashcards
What is the definition of anemia in pregnancy?
Hb level less than 11g/dL in trimester 1 and 3 and <10.5 in trimester 2
What are some of the hematiological changes in pregnancy?
increased plasma volume
30% increase in red cell mass and increased reticulocytes
physiological anemia due to hemodilution as plasma volume increase is greater than red cell mass increase
rise in 23DPG - reduces maternal affinity for oxygen
What are the clinical features of anemia in pregnancy?
shortness of breath lethargy palpitations chest pain headaches dizziness and fainting
on examination: pallor, tachycardia, soft ejection systolic murmur
What are the causes of anemia in pregnancy (while pregnant)?
- Nutritional deficiencies (iron, b12, folic acid)
- physiological anemia
- heamaglobinopathies (sickle cell, thalassemia)
- chronic disease eg. renal failure
- aplastic anemia
- hemolytic anemia (SLE)
- Leukemia, lymphoma
What are the causes of anemia before pregnancy that could affect the pregnancy?
- Menhorrhagia due to fibroids
- Grand multiparity with short pregnancy intervals
- hemoglobinopathies
- parasitic infection
what is the increase in demand for iron in pregnancy?
1000 mg
what is the increase in demand for iron in pregnancy?
1000 mg
How much iron is needed to be absorbed per day?
(T1) 4 to 6.6 mg (T3)
What important questions are to be asked in the history of this patient?
Gynae Hx - fibroids leading to menhorrhagia
obs Hx
grand multi parity w/ little spacing of children, Haemorrhage with child bearing, Haemorrhoids, Parasitic infection, Celiac Disease, Taking supplements as advised?
other
gastric surgery, multiple gestation
what diagnostic tests are done in women w/anemia in pregnancy or suspected cases?
- CBC with WBC differential
- Iron investigations (ferritin decreased, serum iron decreased TIBC increased)
- Stool -occult blood, ova, parasites
- Urine microscopy
- Peripheral blood smear (sickled cells, spherocytes, hypochromic, microcytic)
What dosage of iron is given to expectant mothers?
60-120mg at 16 weeks after vomiting and nausea ends
How do we manage the expectant mother with anemia?
- find the root cause and treat
- treatment depends on severity (eg. symptomatic) and gestation
-outpatient mx depends on whether the Hb will rise to 10g/dl by 40 weeks - ## Hb <4g/dL must be admitted to hospital (cardiac failure possible) and transfused with PRBC
What is the rate of iron increase on oral iron supplements?
No Hb rise in the first week (retic increase)
rise of 1g/dL per week after the 2nd week
Compare oral and parenteral iron use their indications.
Oral
- given to those who can tolerate and are compliant
- side effect GI irritation/constipation
- Raises Hb by 1g/dL weekly
- dose 60-120mg/day
Parenteral (Venofer)
- given to those who cannot tolerate oral or non compliant
- raises Hb faster than oral
- iron needed = normal Hb (13) - patient Hb x 0.25
What is the aim of treatment in anaemic mothers?
To increase Hb to at least 10g/dL by 40 weeks
Why is folic acid needed in pregnancy?
It is integral in the creation of DNA and cell reproduction and growth. There is an increased demand for folate due to the growing fetus
What causes folate deficiency in pregnancy?
- Dietary inadequacy
- anticonvulsant therapy like phenytoin, phenobarb (stop absorption)
- Hemolytic anemia (increase demand)
What are the complications of folate deficiency in pregnancy?
- Neural tube defects
- cleft palate
How is folate deficiency diagnosed?
-CBC- raised MCV-macrocytic
Blood film - macrocytosis and hypersegmentation of polymorph neutrophils
-Decreased folate levels - RBC folate a preferred over plasma folate
Treatment for folate deficiency?
- Propphylaxis - 200-300 mcg folic acid daily
- Once anemia exists - 5mg daily immediately and for weeks after delivery
Who normally experiences B12 deficiency?
In general this deficiency is rare BUT Vegans experience it due to no meat consumption
What is the diagnosis and treatment for B12 deficiency?
- Dx: Serum B12
- Tx : weekly IM cyanocobalamin injections
