Anemia In Pregnancy Flashcards
Past history
Melena,hemetemesis,piles,epistaxia,gi disorders
Bleeding tendency
Worm infestation,walking barefoot
Malnutrition,diarrhea,vomiting
Malaria,tb,rheumatoid arthritis
Epilepsy
Recurrent uti
Hemolytic anemia
Family history
Sickle cell anemia
Thalassemia
Normal values of MCV,mch,mchc
Mcv- 75-95 meu m cubed
Mch-26-31 pg
Mchc-34%
Peripheral smear of IDA
Hypochromic,microcytic,anisocytosis,poikilocytosis
Peripheral smear in megaloblastic anemia
Hyperchromic,macrocytic,hypersegmentation of neutrophils,presence of megaloblasts,Howell jolly bodies
Target cells seen in
Thalasemia
Ida
Presence of eosinophils
Hookworm infestation
Presence of shistocutes in smear indicates
Hemolysis
Normal platelet count
1.5-4 lakhs/ mm cube
Platelets deficient in
Idiopathic thrombocytopenic purpura
Normal total serum iron
65-120 meu g/ dl
TIBC
300-400 meu g/ dl
Normal serum ferritin
15-200 meu g/l
Inv for anemia
HB,RBC,pcv
Peripheral smear
Platelet count
Reticulocyte count
Blood grp,rh type
Bleeding clotting time
Stool examination
Urine
Serum protein
Bone marrow study
Causes of anemia
Nutritional- deficiency of iron,folic acid,vit b12
Due to inc destruction- hemolytic anemia,hemoglobinopathies,malaria
Due to blood loss- heavy menstrual bleeding,hook worm,gi bleeding,obstetric hemorrhage
Due to impaired production - aplastic anemia,chronic renal disease
What is anemia
Decrease in oxygen carrying capacity of blood due to quantitative or qualitative decrease in RBC and hb concentration in blood
ICMR classification of anemia
Mild-10-10.9 g/dl
Moderate-7-10
Severe-4-7
Very severe -<4
FOGSI classification of anemia
Mild-8-10 g/dl
Moderate-6.5-8
Severe-<6.5
Causes of increased iron requirement during pregnancy
Fetus,placenta-300 mg
Maternal hb mass expansion-500 mg,loss by excretion-200 mg
Parturition and lactation-300 mg
Conservation of iron due to amenorrhea -300 mg
Total requirment -1000 mg
Physiological anemia in pregnancy
Hemodilution,results in decrease in hb concentration
Criteria for physiological anemia
Lower limit of hb-10 g/dl
Lower limit of rbc-3.2 mill/ml
Lower limit of pcv-30%
Normal peripheral smear
Anemia prophylaxis
Prophylactic dose of 100 mg elemental iron and 0.5 mg folic acid at least 10/ days after first trimester,from 14-26 weeks,to be repeated 100 days after post partum
Calculation of iron requirement
2.4× wt in kg× hb def in gm+ 1000 mg(to replenish stores)
Stages of iron deficiency
First stage- depletion of iron stores,decrease in ferritin
Second- decrease in serum iron and increase in TIBC
third - IDA
Effect of anemia in fetus
Low birth wt
Iugr
Pre term
Iud
Asphyxia
Feeding difficulty
Antenatal anemia treatment
Oral iron- pregnancy<30 weeks,mild and moderate anemia
Parenteral iron- 30-36 weeks,moderate anemia
Packed RBC transfusion->36 weeks,severe anemia, hemoglobinopathies,acute blood loss
Parenteral iron- preparations
Iron dextran
Iron sorbitol citric acid
Iron sucrose(dose, 100 mg in 100 ml of normal saline iv in 15 min/ day)
Daily requirment of iron
Non pregnant women -2-3 mg a day
Pregnant-6-7 mg a day
Factors that decrease iron absorption
Phytates
Tannins
Phosphates
Calcium
Milk
Tea
Antacids
Ppi
Factors that increase iron absorption
Vit c
Amino acids
Citric acid
Daily requirment of folic acid
500 microgram a day
Complications in pregnancy
Cardiac failure
Subinvolution of uterus
Cortical vein thrombosis
DVT
Morbidity and mortality
Types of hemolytic anemia
Hereditary
. Hereditary spherocytosis
. Hemoglobinopathies
. Glucose 6 phosphate def
Acquired
. Paroxysmal nocturnal hemoglobinuria
Hemoglobinopathies
Sickle cell
Thalasemia
Spherocytosis
Complaints in anemia
Lethargy
Fatigue
Swelling of face,arms,abdomen,feet
Palpitation
Breathlessness
Chest pain
