Other Anemias in Pregnancy

1. MEGALOBLASTIC ANEMIAS DURING PREGNANCY

2. DIMORPHIC ANEMIA
3. ANEMIA FROM ACUTE BLOOD LOSS
4. HEMOLYTIC ANEMIAS
5. HEMOGLOBINOPATHIES
(a) Alpha Chain Defects
(b) Beta Chain Defects- (i) Beta Thalassemia Major (ii) Beta Thalassemia Trait (Minor).
6. SICKLE CELL HEMOGLOBINOPATHIES IN PREGNANCY

1. Deficiency Megaloblastic Anemia:- The incidence varies from 0.5-3%

Causes:-

(a) Folate Dietary deficiency: Food lacking in green vegetables, fruits, liver, kidney with
prolonged cooking of food.
(i) Hyperemesis gravidarum
(ii) Malabsorption syndromes: Tropical sprue, celiac disease.
(iii) Drugs: Anti-epileptic drugs (eg. Phenytoin, pyrimethamine and trimethoprim)

Investigations:-

(i) Fall in Hb concentration to < 11 g/dL.

(ii) MCV > 96 fl, MCH>33 pg and normal MCHC.
(iii) Peripheral blood film: There is macrocytic (megaloblastic) anemia with
normochromia with hypersegmentation of neutrophils.
(iv) Anisocytosis
(v) A combination of low serum folate (<3 ng/mL) and red cell folate (<150 ng/mL) is
diagnostic of folic acid deficiency.

Prophylaxis:-

The WHO recommends a daily folate intake of 800 ug in the antenatal period and 600 ug
during lactation. However, 300-500 ug present in most iron preparations is enough for
prophylaxis.

Treatment:-

Treatment of established folic acid deficiency is by giving 5 mg oral folate perday which
should be continued upto 4 weeks in puerperium. Response is indicated by a fall in LDH
levels within 3-4 days and an increase in reticulocyte count in 5-8 days.

(b) Megaloblastic Anemia due to Vitamin B12(Cyanocobalamin) Deficiency

Causes:-

(i) Inadequate diet- Strict vegetarians

(ii) Malabsorption

Clinical Features:-

(i) Hematologic manifestations

(ii) Gastrointestinal manifestations
(iii) Neurological manifestations

Investigations:-

(i) Findings are the same as in folate deficiency. Vitamin B 12 levels are lower in blood
(<90 ug/l).
(ii) Serum methyl malonic acid is elevated in Vitamin B12 deficiency.
(iii) Serum homocysteine is elevated in both folate and Vitamin B12 deficiency.
(iv) The deoxyuridine suppression test can differentiate between Vitamin B 12 and folate
deficiency.
(v) Schilling test used to diagnose pernicious anemia is not done during pregnancy as it
uses contrast.

Treatment: - Parenteral Cyanocobalamin (250 ug) is given intramuscularly every month.

Treating megaloblasticanemia due to Vitamin B12 deficiency with folate alone may precipitate
neurological manifestations.

7. DIMORPHIC ANEMIA
8. ANEMIA FROM ACUTE BLOOD LOSS
9. HEMOLYTIC ANEMIAS
10. HEMOGLOBINOPATHIES
(c) Alpha Chain Defects
(d) Beta Chain Defects- (i) Beta Thalassemia Major (Cooley ’s anemia), (ii) Beta
Thalassemia Trait (Minor).
11. SICKLE CELL HEMOGLOBINOPATHIES IN PREGNANCY