Anemia In Pregnancy Flashcards
Define anemia in pregnancy
Who definition says less than 11.0g/dl
However caribbean it’s less than 10.0g/dl
Describe physiological anemia
Plasma volume increases in early second trimester and peaks 32-34 weeks gestation by about 1250-1500ml (singleton pregnancy)
Rbc increases by 400-500 ml
Therefore anemia is due to a “dilutional anemia” where there is greater increase in plasma volume compared to rbc
Aka lower rbc to plasma volume ratio
(Nb oxygen delivery to fetoplacental unit preserved because of increase maternal 2,3 DPG)
Clinical features of anemia in pregnancy
Lethargy, sob, Palps, chest pain, dizziness, fainting, pica in ida, chf symptoms of severe such as orthopnoea and pnd
Signs: pallor tachycardia soft ejection systolic murmur, signs of chf, jaundice if hemolytic
What is the commonest hematological problem in pregnancy
IDA
What is the total requirement of iron in pregnancy
1000mg
What is the daily requirement of iron in pregnancy
4mg/day
What is the first abnormal lab test in IDA
Serum ferritin (symptoms develop after stores diminish)
Also see microcytic hypochromic anemia
Decreased serum iron
Increased tibc however not used in pregnancy as it is increased even in normal pregnancies
Treatment of ida in pregnancy
Oral iron initially
Prophylactically started at 16/40 weeks after the nausea and vomiting subsided
What do you do if too late in pregnancy and the 10 g/dl goal by 49 weeks not achieved
Consider transfusion with packed rbcs
What is the formula for calculating the dosage of parenteral iron to be given to patients who can’t tolerate oral iron due to side effects
(Normal person haemoglobin, 13- patient hb) x0.25 = IV iron dose
Why do we give folic acid during pregnancy
Folic acid necessary for closure of the neural tube during fetal development (which occurs by day 28)
So a fetal complication of deficiency in trimester 1 is neural tube defects
Etiology of folic acid deficiency
Nutritional deficiency
Frequent childbirth
Multiple pregnancy
Anticonvulsant therapy such as phenytoin and phenobarbitone
Hemolytic anemia eg scd, thalasaemia
Clinical features of folic acid def
Anorexia nausea vomiting diarrhea (GI)
Others: pallor depression uti sore mouth and tongue
What is the treatment of folic acid deficiency
Prophylaxis: 300-500 mcg/ day
Established case: 5 mg /day
Maternal complications of scd in pregnancy?
Increased risk of spontaneous miscarriage
Increased risk of infections esp pyelonephritis, pneumococcal pneumonia
Increased risk of thromboembolism
Increased risk of pre eclampsia
Preterm labour
