Anemia in pregnancy

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Anemia In Pregnancy

Definition:

Hb = 10 gm/dl or less

Hct = 35%

Incidence:

< 5% of pregnant ladies

Significance:

( Fetal Morbidity & Mortality

( Infection rate

( Decompensation in mothers w/ Cardiac or Pulmonary dis

Exacerbate the effect of Hemorrhage

Delays recovery in the Post Partum period

General Symptoms of Anemia :

1- Lethargy.

2- Tiredness.

3- Headache.

4- Dizziness.

5- Dyspnea.

6- Dysphagia. IDA

7- Palpitation: b/c ( blood volume in pregnancy physiological tachycardia.

8- ( risk of Hge during pregnancy & labor** These symptoms are found in any pregnant woman

but in anemic patients these symptoms will be more severe.

Signs:

1- Pallor in palms, nail bed, mucus membrane and conjuctiva.

2- Cyanosis.

3- Splenomegaly.

4- In severe anemia:

Heart failure

Lower limb edema.

General Causes of Anemia in Pregnancy:

( Requirements Multiple pregnancy

( frequency of pregnancy ( < 2 y apart)

( Intake poor diet

Hyperemesis gravidarum esp in early pregnancy

( storage liver disease

Abnormal absorption d/t changes in the GIT

Chance of Hemorrhage

Clinical classification:

1- Iron deficiency anemia. 85%

2- Megaloblastic anemia.

3- Secondary anemia (2%):

Chronic infections specially pyelonephritis.

Recurrent bleeding.

Malignancy.

4- Hemolytic anemia:

SCD (3.5%).

Thalassemia.

5- Aplastic anemia, which is rare these days.

Physiological Anemia in Pregnancy:

** Hematological changes in Pregnancy:

( plasma volume by 40% w/ a platue at 28 w

( RBC mass by 32% w/ a platue at 30 w

( total Hb mass by 15%

This will lead to Hemodilution

~ ( Hb = 11 g/dl , but not less than 10mg/dl.

& (Hct = 37%

During 1st 48 hr post partum Hemodilution

B/c interstitial fluid enters circulation

After 1st 48 hr post partum Hemoconcentration

After 6-8 w post partum Back to normal

Iron Deficiency Anemia

# This is the most common type of anemia in pregnancy (80%).

Normal Physiology of Iron:

Iron Requirements:

average adult = 4-5 gm

In pregnancy = an extra 1gm

Iron Sources:

1- Red meat, liver and kidneys.

2- Green leaves and vegetables.

3- Fruits like Banana.

Iron Absorption:

Site = Upper small intestine = duodenum & jejunum

Amount = 1/10th dietary iron

Iron Storage:

Site = RES

Amount = 30%

Form = Hemosiderine

Iron Excretion:

Route = urine, feces, menstrual bl, skin desquamation

Amount = 1mg/day

Importance of Iron in Pregnancy:

( RBC mass 350 mg needed

Uterus & its contents 350 mg for fetus, 100 mg for placenta

Loss of iron during delivery & in lochia 150 mg

Lactation 150 mg

Causes:

A. ( demand and requirement in pregnancy

B. ( Intake: ( appetite , vomiting.

C. ( Storage Multiple pregnancies

D. Improper Metabolization & Utilization.

E. Abnormal absorption.

# Note

The iron loss starts with depletion of iron stores

~ ( iron serum levels (10 gm/dl)

~ ( iron binding capacity (16)

~ morphologic changes in RBCs microcytic hypo chromic.

Investigations:

1- CBC (microcytic hypo chromic).

2- (Serum iron- (NL= 34-150).

3- (Serum ferritin- (NL = 6-31)

4- (TIBC

5- Bone marrow if needed

Recommendation:

1- Adequate diet rich in iron = 15 mg/day

2- Iron prophylaxis.

Ferrous SO4 200 mg twice daily

Start giving pregnant women after 1st trimester (12 weeks), because:1- There will be enough iron storage for the 1st trimester.

2- In the 1st trimester there is N/V and the iron irritates the stomach causing more N/V. so some patients will stop taking it.

3- There is less N/V in the 2nd trimester onwardsTreatment:

Depends on severity of anemia and gestational age:

1- In late 3rd trimester & severe anemia (