Anaemia in pregnancy

Anaemia in pregnancy

Less than 5% in developed countries.
Physiological changes in pregnancy:-
Plasma volume increase by 20% by 15 weeks & 50% by 30-34 weeks (1250 ml).
RBC increase by 14% (180 ml) without supplementation & 28%(350 ml) when extra iron & folic acid given .

Diagnosis of anemia in pregnancy:-
Hb 10 gm / dl , pcv : 35 % .

Iron deficiency anemia:-
80% of anemia in pregnancy .
Fetus , placenta :500mg iron
Increase RBC mass 500mg
Postpartum blood loss : 180 mg
Lactation for 6 months : 180 mg
Total requirement : 1360 mg iron .

Hematological features:-
1.Hb, pcv% decrease.
2.Blood film :hypochromic microcytic
3.B.M exam .special stain ,absence of iron.
4.serum iron decrease
5.I.B.C increase
6.serum ferritin decrease
I.D.A.:serum iron decrease ,I.B.C increase , serum ferritin decrease .
Infection :serum iron decrease , I.B.C increase , serum ferritin increase .

Management:-
1.Prevention.
2.Treatment of established anemia:-
Depend on :
a.severity of anemia
b.Nearness to term
c.other complications like placenta previa .

Treatment:-
1.Oral iron
2.Injectable iron
3.Blood transfusion.

Injectable iron ;
1.Normal Hb –patient Hb .weight (Kg) .2.2 +1000 =mg of iron needed .
2. 250 mg elemental iron for each 1 gm Hb .
Follow up : reticulocytes , Hb.

Megaloblastic anemia :-
Non pregnant : 50 ug/ day.
Pregnant : 350-400 ug /day.