1. 1. ANEMIA AND PREGNANCY Supervised By: Dr.Sausan Presented to you By: Shams Kareem Rose Razzaq Mohammed Tawffeq Mohammed Haroon
2. 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. 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. 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. 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. 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. 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. 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. 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. 10. HOW ANEMIA IS DIAGNOSED?
11. 11. BY EXAMINATION :-
12. 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. 13. IRON DEFICIENCY ANAEMIA (IDA) This Is Most Common Type Of Anaemia. Hematologicaly described as Microcytic Hypochromic Anaemia . More common in developing countries
14. 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. 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.
16. 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.
17. 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 .
18. 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 .
19. 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.
20. 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 .
21. 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)