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- 1. ANEMIA AND PREGNANCY Supervised By: Dr.Sausan Presented to
you By: Shams Kareem Rose Razzaq Mohammed Tawffeq Mohammed
Haroon
- 2. ANAMIA IN PREGNANCY. Commonest medical disorder in
pregnancy. 18-20 pregnant women are anaemic in developed countries
as compared to 40-75 % in developing countries . It is
responsible(directly / contributory factor ) for significant high
maternal and fetal mortality and mortality throught out world , but
more so in developing nations.
- 3. WHO DEFINITION OF ANAEMIA IN PREGNANCY For diagnosis of
anaemia in Pregnancy when HB concentration is < 11 gm% (
7.45mmol/ L)and a haematocrit of < 0.33. Mild------------ 8 10
mg % Moderate ---- 5 < 8 mg % Severe---------- < 5 mg %
- 4. WHY DOSE IT OCCUER ?! (PHYSIOLOGY) During Pregnancy there is
increase in total blood volume (1500 ml = 30 - 40%), plasma
volume(250 ml = 40-50 %) as well as the EBC volume (350ml = 20 -30
% ) also , But increment in plasma volume is more then the
increased total hemoglobin(15-20 % ). Hence there is dilution of
blood, resulting in physiological anaemia( upper limit for normal /
100% Hb level in pregnancy is brought down to 11gm % ) .
- 5. SOURCES OF VARIOUS NUTRIENT REQUIRED FOR ERYTHROPOESIS
Nutrients Sources Iron Haem Iron :Animal blood , flesh , viscera (
live Kidney , red meat , poultry and fish ( including muscles ) Non
Harem Iron : green leafy vegetables, cereals , seeds , Vegetables (
peas , backed beans ) roots and tubes , japery , Cooking in iron
vessels < urinal , Dates etc . Folic Acid Green Vegetables (
palak, Maithy , bathali , Broccoli ) Fruits , Germinate wheat ,
Liver and Kidney. Cyanocobalamin ( Vit B12 ) Meat , fish , eggs ,
milk Ascorbic Acid ( vit. C ) Citrus fruits , Amala ( indian
gooseberry ) Other Vit,B Green leafy vegetables and fruits
- 6. TYPES OF ANAEMIA DURING PREGNANCY Physiological anemia
Pathological anemia icluding : 1 . Hereditary causes Thalassaemias
, Sickle Cell Haemoglobinopathies , Haemolytic anaemias , other
type of Haemgobinopathies.
- 7. 2 .Acquired Causes A . Nutritional---Iron deficiency anaemia
( microcytic hypocromic anaaemia , Folate deficiency anaemia (
megaloblastic anaemia ) , Vit B 12 Deficiency anaemia (
Megaloblastic anaemia ) B . Anaemia due to bone marrow failure (
aplstic / hypo plastic anaemia ). C . Anaemia secondary to
inflammation , chronic disease , malignancy. D . Anemia due to
acute / chronic blood loss. E . Acquire hemolytic anemia. Note Iron
Deficiency anemia is most common in developing countries like
ours
- 8. CLINICAL FEATURES OF ANAEMIA IN PREGNANCY Symptoms Signs
Weakness Pallor . Lassitude , tiredness , exhaustion Glossitis .
Indigestion Stomatitis . Loss of appetite Oedema Palpitation
Hypoproteinaemia . Breathlessness Soft systolic murmur in mitral
area due to hyperdynamic circulation Giddiness / dizziness Fine
crepitations at lung bases. Swelling feet eye lids ( peripheral )
Pale nails . Platynaechoea . Koilonaechia Generalized anasarca.
Tenderness in sternum . Blackouts in front of eyes on sudden
standing Hepatic splenic enlargement . Symptoms of congestive
cardiac failure
- 9. EFFECTS OF ANAEMIA ON PREGNANCY . Maternal Foetal Weakness
Preterm baby Lack of energy Small for gestation Fatigue PET
Increased perinatal morbidity and mortality Poor work performance
Iron deficiency Palpitation tachycardia Cognitive and affective
dysfunction in the infant Even mild bleeding in APH or PPH can
endanger the life Increased incidence of diabetes and cardiac
disease in later life Breathlessness Increase cardiac output
Cardiac decomposition Cardiac failure Increased incidence of
preterm labour Sepsis
- 10. HOW ANEMIA IS DIAGNOSED?
- 11. BY EXAMINATION :-
- 12. IRON Iron is a critical element in the function of cells,
Body should protect itself from ill effect of excessive iron as it
is highly toxic ,as it generates free radicals such as singlet O2 /
OH + Major role of iron (ferrous form ) is to carry O2 as part of
hemoglobin . O2 is also bound by myoglobin An iron compound present
in muscles. Iron is a critical element of iron containing enzymes
including cytochrome system in mitochondria.
- 13. IRON DEFICIENCY ANAEMIA (IDA) This Is Most Common Type Of
Anaemia. Hematologicaly described as Microcytic Hypochromic Anaemia
. More common in developing countries
- 14. Causes can include : . Low Dietary Intake Of Iron ,
.Chronic Intestinal Disease Like Amoebiasis, Sprue, Diarrhoea,
Parasitic Infestation (Hook Worm) .Malaria , . Schistosomiasis ,
.Phytates In Diet, .chronic Blood Loss (Menorrhagia , Piles,
Fissure In Ano )
- 15. DIAGNOSIS OF IDA Characteristics Calculation Normal Range
IDA Hb gm % Sahlis method 11-15 < 11 Mean corpuscular
volume(MCV) PCV/RBC 75-96 4 weeks . Response is observed by fall in
LDH level in 3-4 days and increase in reticulocyte count in 5-8
days.
- 35. COBALAMINE (VIT .B12 ) DEFICIENCY A rare cause of anaemia
in pregnancy . , as daily requirement of 3ug is easily met with a
normal diet . Pernicious anaemia due to absence of intrinsic factor
, resulting in decrease absorption of Vit B12 is rare in pregnancy
., as it usually causes infertility.
- 36. COBALAMINE (VIT .B12 ) DEFICIENCY Clinical findings are
same as in folic deficiency . Vit B12 level is lower in the blood (
< 90ug / L) Deoxyuridine test can differentiate in two .
Parenteral Vit B12(cynocobalamin ) 250ug / month is the treatment.
Gastric mucosal atrophy following long term use of H2 inhibitor and
Proton pump inhibiting anta acid will result in deficiency of
intrinsic factor and decreased absorption of Vit B12 .
- 37. HAEMOGLOBINOPATHIES Each molecule of normal Hb is composed
of 4 subunits , with a single heam group and 4 species specific
globin chains . 2 pairs of globin chains ( 2 alpha & 2 Beta
chains ) are attached to the Pyrole rings to make normal Hb . The
integrity of the Heam moety and amino acid sequence of globin chain
determine the structure of the globin chain and interaction between
the 4 sub units of the Hb .
- 38. THALASSAEMIA Characterized by impaired of one or more of
globin chains . ALPHA Thalassaemia when alpha chains are impaired .
If only one alpha chain is impaired the it is called Alpha
Thalassaemia Trait.
- 39. THALASSAEMIA Beta thalassaemia When both Beta chains are
impaired. Beta Thalassaemia Trait if only one Beta chain is
impaired. Children With Beta Talassaemia usually die before
reaching reproductive age . Repeated blood transfusion and Iron
chelating therapy some women remain alive , get married and become
pregnant. These women suffer from chronic anaemia which need to be
differentiated from IDA., by Blood indices and Hb F and HbA 2
Levels .
- 40. D/D OF IDA & THALASSAEMIA Characteristics Normal Range
IDA Thalassaemia MCV 75-96 Reduced Very Reduced Mean Corpuscular Hb
27-23 Reduced Very Reduced Mean Corpuscular Hb Conc. 32 -35 Reduced
Normal Fetal HB (HbF)