Anemia in pregnancy

Anemia in pregnancy ; physiological, IDA, Megaloblastic anaemia along with WHO guidelines.

1. Dr.Nishant Kumar Thakur MD Obstetrics & Gynaecology ANEMIA IN PREGNANCY

2. WHAT IS ANAEMIA? Anaemia is a condition in which the number and size of red blood cells, or the haemoglobin concentration, falls below an established cut-off value, consequently impairing the capacity of the blood to transport oxygen around the body.

3. WHAT CAUSES ANAEMIA? The most common cause of anaemia worldwide is iron deficiency, resulting from prolonged negative iron balance, caused by inadequate dietary iron intake or absorption, increased needs for iron during pregnancy or growth periods, and increased iron losses as a result of menstruation and helminth (intestinal worms) infestation. An estimated 50% of anaemia in women worldwide is due to iron deficiency. Other important causes of anaemia worldwide include infections, other nutritional deficiencies (especially folate and vitamins B12, A and C) and genetic conditions (including sickle cell disease, thalassaemia – an inherited blood disorder – and chronic inflammation).

4. INTERVENTIONS FOR PREVENTION AND CONTROL OF ANAEMIA

5. Improvements in the prevalence of anaemia among women of reproductive age have been seen in countries around the world: for example, Burundi (64.4% to 28% in 20 years); China (50.0% to 19.9% in 19 years); Nepal (65% to 34% in 8 years); Nicaragua (36.3% to 16.0% in 10 years); Sri Lanka (59.8% to 31.9% in 13 years); and Viet Nam (40.0% to 24.3% in 14 years).

6. CLASSIFICATION

7. Pathological anemia

8. Pathological anemia

9. CAUSES OF INCREASED PREVALENCE OF ANEMIA IN TROPICS

10. But if the iron reserve is inadequate or absent, these factors lead to the development of anemia during pregnancy:

11. Physiological anaemia

12. CRITERIA OF PHYSIOLOGICAL ANAEMIA: The lower limit of physiological anemia during the second half of pregnancy should fulfill the following hematological values: Hb-10 gm% RBC-3.2 million/mm3 PCV-32%. Peripheral smear showing normal morphology of the RBC with central pallor.

13. Clinical Features Mostly asymptomatic. Most cases present with symptoms in the third trimester when the demand for iron is greatest. Symptoms: Fatigue, Shortness of breath, Weakness and Dizziness. Signs Tachycardia and Pallor of non-pigmented areas of the skin such as the nail beds, palms of the hands, the conjunctiva or the oral mucosa.

14. PATHOLOGICAL ANAEMIA

15. IRON DEFICIENCY ANAEMIA

16. CLINICAL FEATURES Symptoms: Usually asymptomatic. Lassitude and fatigue or weakness. Anorexia and indigestion; Palpitation (caused by ectopic beats), Dyspnea, Giddiness and Swelling of the legs.

17. Clinical features Signs: Pallor of varying degrees Glossitis and stomatitis. Edema of the legs (due to hypoproteinemia or associated preeclampsia). A soft systolic murmur (in the mitral area due to physiological mitral incompetence). Crepitations (heard at the base of the lungs due to congestion).

18. Diagnosis and Laboratory Assessments

19. The objectives of investigation are to ascertain

20. To note the degree of anemia: Hemoglobin, Total red cell count, P acked cell volume.

21. To ascertain the type of anemia: Peripheral blood smear : Abundant presence of small pale staining cells with variation in size (anisocytosis) and shape (poikilocytosis) suggest microcytic hypochromic anemia. This is typical in iron deficiency anemia. Reticulocyte count may be slightly raised. Hematological indices: MCHC, MCV and MCH MCHC is the most sensitive index of iron deficiency anemia. It should be remembered that these hematological indices should supplement and not substitute the blood smear examination for correct typing of anemia.

22. A typical iron deficiency anemia shows the following blood values: Hemoglobin—less than 10 gm%, red blood cells —less than 4 million/mm3 , PCV—less than 30%, MCHC— less than 30%, MCV— less than 75 µ3 and MCH—less than 25 pg.

23. To find out the cause of anemia:

24. Bone marrow biopsy: Cases not responding to therapy according to hematological typing. To diagnose hypoplastic anemia. To diagnose kala-azar by detecting L.D. bodies. In iron deficiency anemia, the bone marrow is normoblastic in character. There is absence of hemosiderin granules when stained with Prussian blue.

25. Diagnosis

26. Diagnosis

27. TREATMENT

28. PROPHYLACTIC

29. WHO recommendations

30. CURATIVE

31. IRON

32. Oral therapy

33. The improvement should be evident within 3 weeks of the therapy. After a lapse of few days, the hemoglobin concentration is expected to rise at the rate of about 0.7 gm/ 100 mL/week. Contraindications of oral therapy: Intolerance to oral iron. Severe anemia in advanced pregnancy.

34. PARENTERAL IRON

35. Indications of parenteral therapy

36. SUMMARY OF CURRENT WHO RECOMMENDATIONS FOR THE PREVENTION, CONTROL AND TREATMENT OF ANAEMIA IN WOMEN Intermittent iron and folic acid supplementation is advised in menstruating women living in settings where the prevalence of anaemia is 20% or higher. Daily oral iron and folic acid supplementation is recommended as part of antenatal care, to reduce the risk of low birth weight, maternal anaemia and iron deficiency. In addition to iron and folic acid, supplements may be formulated to include other vitamins and minerals, according to the United Nations Multiple Micronutrient Preparation (UNIMAP), to overcome other possible maternal micronutrient deficiencies.

37. MEGALOBLASTIC ANEMIA

38. Common causes of Vit B12 deficiency

39. Folic Acid Deficiency

40. CAUSES OF FOLIC ACID DEFICIENCY IN PREGNANCY

41. CAUSES OF FOLIC ACID DEFICIENCY IN PREGNANCY

42. Prevention Diet sufficient in folic acid Folic acid 400mcg daily More folic acid is given in circumstances like multifetal pregnancy, hemolytic anemia, Crohn disease, alcoholism, and inflammatory skin disorders. There is evidence that women who previously have had infants with neural-tube defects have a lower recurrence rate if a daily 4mg folic acid supplement is given pre-conceptionally and throughout early pregnancy.

43. Treatment Folic acid along with iron Folic acid in the dose of 1mg/day