ANAEMIA IN PREGNANCY.................ppt

Anemia

1. ANAEMIA IN PREGNANCYANAEMIA IN PREGNANCY
AHMED ABDULWAHABAHMED ABDULWAHAB

2. •objectives
•1-describe the physiological changes in pregnancy
increasing the risks of anemia
•2- List the different types of anemia in pregnancy
•3- Describe the sign and symptoms in anemic pregnant
lady
•4- List the different investigations to identify the
causes of anemia
•5-justify different mode of managements for anemia
according to the type severity and gestational age

3. •Justify different mode of managements Justify different mode of managements
for anemia according to types severity for anemia according to types severity
and gestational age . and gestational age .

4. •It is the commonest medical disorder of It is the commonest medical disorder of
pregnancy.pregnancy.
•Physiological changes.Physiological changes.
•Plasma volume increase by 50%.Plasma volume increase by 50%.
•Red cell mass increase by 25%.Red cell mass increase by 25%.
•Fall in Hb concentration and haematocrit Fall in Hb concentration and haematocrit
due to haemodilution.due to haemodilution.
•MCV increase secondary to erythropoiesis.MCV increase secondary to erythropoiesis.

5. •Cont,Cont,
•MCHC remain stable.MCHC remain stable.
•Serum iron and ferritin decrease because of Serum iron and ferritin decrease because of
utilization .utilization .
•Total iron binding capacity increases TIBCTotal iron binding capacity increases TIBC
•Iron requirement increases total of 1000 mg in Iron requirement increases total of 1000 mg in
whole pregnancy.whole pregnancy.
•Moderate increase in iron absorption .Moderate increase in iron absorption .
•Folate requirement increasesFolate requirement increases

6. •DEFINTION..DEFINTION..
•WHO recommended that Hb WHO recommended that Hb
concentration should fall below 11gm/dl concentration should fall below 11gm/dl
in pregnancy to diagnose anemia.in pregnancy to diagnose anemia.
•Incidence 30-50% pregnant women are Incidence 30-50% pregnant women are
having anemia at pregnancy.having anemia at pregnancy.
•90% have iron deficiency anemia .90% have iron deficiency anemia .
•5% folate deficiency .5% folate deficiency .

7. •CLINICAL FEATURE.CLINICAL FEATURE.
•Often asymptomatic.Often asymptomatic.
•Diagnosed in routine screening .Diagnosed in routine screening .
•Other ,tiredness, dizziness ,fainting , Other ,tiredness, dizziness ,fainting ,
pallor may be apparent pallor may be apparent

8. •SCREENING .SCREENING .
•Routine screened by Hb concentration Routine screened by Hb concentration
at the beginning of pregnancy .at the beginning of pregnancy .
•It is cheep and simple..It is cheep and simple..
•It does not reveal the cause .It does not reveal the cause .

9. •IRON DEFICENCY ANAEMIA .IRON DEFICENCY ANAEMIA .
•It is microcytic hypochromic . Reduced MCV . It is microcytic hypochromic . Reduced MCV .
MCHC.MCHC.
•Etiology .Etiology .
•Increase demand in pregnancy due to Increase demand in pregnancy due to
expanding red cell mass, fetal requirement .If expanding red cell mass, fetal requirement .If
iron stores are depleted because of iron stores are depleted because of
menstruation , recurrent pregnancy ,poor menstruation , recurrent pregnancy ,poor
intake , anemia develops rapidly intake , anemia develops rapidly

10. •CONSEQUENCES .CONSEQUENCES .
•Preterm labor.Preterm labor.
•Infection Infection
•Medical intervention during labor .Medical intervention during labor .
•Post partum blood loss.Post partum blood loss.
•? IUGR.? IUGR.

11. •TREATMENT.TREATMENT.
•Oral iron is effective when there is Oral iron is effective when there is
time .time .
•Hb increase 0.8 g/dl per week Hb increase 0.8 g/dl per week
• Side effect depends on the amount of Side effect depends on the amount of
the of the elemental iron .the of the elemental iron .
•Choice depends on cost and patient Choice depends on cost and patient
tolerance .tolerance .

12. •Cont.Cont.
•Vitamin –C helps absorption .Vitamin –C helps absorption .
•Main side effect are gastro intestinal , Main side effect are gastro intestinal ,
gastric upset and constipation .gastric upset and constipation .
•Indication for parenteral thereby .Indication for parenteral thereby .
•Lack of compliance , severe GIT side effect, Lack of compliance , severe GIT side effect,
mal absorption mal absorption
•Intera muscular iron sorbitol Intera muscular iron sorbitol

13. •Cont.Cont.
•Deep im it is painful cause discoloration of the Deep im it is painful cause discoloration of the
skin .skin .
•High level may be excreted before utilization .High level may be excreted before utilization .
•IV IRON .IV IRON .
•Iron saccharate cause more rapid rise in Hb and Iron saccharate cause more rapid rise in Hb and
has fewer side effect compared to oral iron , but has fewer side effect compared to oral iron , but
more invasive and need admission to hospital more invasive and need admission to hospital

14. •ContCont
•Blood transfusion Blood transfusion
• Most rapid way to increase the Hb .Most rapid way to increase the Hb .
•Used when there is no time to correct Used when there is no time to correct
anemia especially when there is an anemia especially when there is an
obstetrical problem eg, placenta previa obstetrical problem eg, placenta previa
•Risks include allergy and transmission Risks include allergy and transmission
of infectionof infection

15. •Cont.Cont.
•Prevention is possible with good balanced diet .Prevention is possible with good balanced diet .
•Spacing pregnancies .Spacing pregnancies .
•Identification and treatment of iron deficiency Identification and treatment of iron deficiency
prior to pregnancy are optimal .prior to pregnancy are optimal .
•Routine iron supplementation in pregnancy Routine iron supplementation in pregnancy
improve in hematological indices.improve in hematological indices.