ANAEMIA IN PREGNANCY

AHMED ABDULWAHAB

 It is the commonest medical disorder of

pregnancy.
Physiological changes.
Plasma volume increase by 50%.
Red cell mass increase by 25%.
Fall in Hb concentration and haematocrit
due to haemodilution.
MCV increase secondary to erythropoiesis.

 Cont,
MCHC remain stable.
Serum iron and ferritin decrease because of

utilization .
Total iron binding capacity increases TIBC
Iron requirement increases total of 1000mg in
whole pregnancy.
Moderate increase in iron absorption .
Folate requirement increases

 DEFINTION..
WHO recommended that Hb

concentration should fall below 11gm/dl

in pregnancy to diagnose anemia.
Incidence 30-50% pregnant women are
having anemia at pregnancy.
90% have iron deficiency anemia .
5% folate deficiency .

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

 SCREENING .
Routine screened by Hb

concentration at the beginning of

pregnancy .
It is cheep and simple..
It does not reveal the cause .

 IRON DEFICENCY ANAEMIA .

It is microcytic hypochromic . Reduced

MCV . MCHC.
Etiology .
Increase demand in pregnancy due to
expanding red cell mass, fetal requirement
.If iron stores are depleted because of
menstruation , recurrent pregnancy ,poor
intake , anemia develops rapidly

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

 TREATMENT.
Oral iron is effective when there is time .
Hb increase 0.8 g/dl per week
Ferrous salt is better absorbed than the

ferric form .
Side effect depends on the amount of the
of the elemental iron .
Choice depends on cost and patient
tolerance .

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

 Cont.
Deep im it is painful cause discoloration
of the skin .
High level may be excreted before
utilization .
IV IRON .
Iron saccharate cause more rapid rise in
Hb and has fewer side effect. Compared

 Cont
To oral iron but more invasive , need

admission to hospital , it is true alternative to

blood transfusion.
Blood transfusion ,
Most rapid way to increase the Hb .
Used when there is no time to correct
anemia .
Risks include allergy and transmission of
infection

 Cont.
Prevention is possible with good balanced

diet .
Identification and treatment of iron
deficiency prior to pregnancy are optimal .
Routine iron supplementation in pregnancy
improve in hematological indices.