Anemia in pregnancy (Iron deficiency)
WOMEN HEALTH IN CAMBODIA
ANAEMIA IN PREGNANCY
RISK FACTOR ANEMIA
NORMAL IRON CYCLE
SIGN AND SYMPTOM OF ANEMIA
MANAGEMENT
Introduction:
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 Ht due to haemodilution.
7. ANAEMIA IN PREGNANCY
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 Ht due to
haemodilution.
8. Definition: Anemia Hb concentration should
fall below 11g/dl (or Ht <32%) in pregnancy
to diagnose anemia.
WHO grading of anemia
Mild anemia 10 g/dl
Moderate anemia 7- 10 g/dl
Severe anemia < 7g/dl
ANEMIA IN PREGNANCY
9. Prevalence Anemia
Prevalence in pregnant women
– 14 % - Developed Countries
– 51% - Developing Countries
– 65-75% - India
– 80 % leading to maternal deaths
90% have iron deficiency anemia
5% folic acid deficiency
10. Common Anemia in pregnancy
1) Nutritional Deficiency
- Iron deficiency
- Folic acid deficiency
- Vit. B12 deficiency
2) Hemoglobinopathies
- Thalassemia
- Sickle Cell Disease (susceptible hypoxia when O2 supply reduced)
- Rare types: Aplastic, Leukemia, Autoimmune hemolytic,
3) Red blood cell loss:
Menorrhagia 20-30%
12. Normal iron metabolism
The primary function is oxygen transport.
Iron is absorbed by duodenum and jejunum
Average total body iron content 3500-4000 mg.
Approximately 2/3 found in hemoglobin,
Iron is also stored in RE cells (Bone marrow,
Spleen and liver) as hemosiderin and ferritin.
Transport of electrons within cells
Co-factor of essential enzymatic : Heme
Immunity: free radicals to destroy microbes
25. MANAGEMENT (1)
Objectives:
1- To achieve a normal Hb by end of pregnancy
2- To replenish iron stores
Two ways to correct anemia:
1- Iron supplementation: Oral and Parenteral
2- Blood transfusion
Choice of method: depends on 3 main factors:
1- Severity of the anemia
2- Gestational Age
3- Presence of additional risk factor
26. MANAGEMENT (2)
Improving diet rich in iron &
fruits & leafy vegetables
Treat worm infections,
maintain general hygiene
Food fortification with iron &
genetic modification of food
Iron & folic acid
supplementation in young
girls & during pregnancy
27. MANAGEMENT (3)
WHO - 60 mg Elemental iron + 400
micro gram Folic acid/day * 6 months
& 3 months postpartum
In anemia therapeutic doses are
120-200 mg /day
Iron supplementation not
recommended in first trimester
– Higher incidence of miscarriage
– Birth defects
– Bacterial infection (bacteria grow
after taking iron from
supplementation)
28. MANAGEMENT (4)
Severe anemia: (Hb < 8gm/dl)
Parenteral therapy in IM or IV iron
- IM : Iron sorbitol
- IV : Iron sucrose
Blood transfusion:
May be required to treat severe anemia near term or
when some other complication such as placenta
praevia present.
Gross anemia
• Packed red cells transfusion
• Exchange transfusion
29. Side Effect of Fer
Side effect of Fe Oral therapy:
. G. I upset.
. Constipation.
. Diarrhea.
Parenteral:
- Skin discoloration
- Local abscess
- Allergic reaction
- Fe over load.
30. SUMMARY
ANAEMIA IN PREGNANCY (Iron deficiency)
Most common form of anemia
Symptom of pathologic process
Primary manifestation is hematologic
Treatment requires:
– Replacement therapy
– Correction of underlying cause (if possible)
Iron excess more dangerous than iron
deficiency (Hemochromatosis)
31. Disease slide for public
Please consult your physicians for further information.
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