O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.

Anemia in pregnancy

2.650 visualizações

Publicada em

Anaemia in Pregnancy

Publicada em: Saúde e medicina
  • Seja o primeiro a comentar

Anemia in pregnancy

  1. 1. Anemia in pregnancy Update 1/11/2014 Juliana Mohd Basuni
  2. 2. definition  defined as a decrease in the amount of red blood cells (RBCs) or the amount of hemoglobin in the blood. Anemia". http://www.merriam-webster.com/. Retrieved 7 July 2014. Stedman's medical dictionary (28th ed. ed.). Philadelphia: Lippincott Williams & Wilkins. 2006. p. Anemia. ISBN 9780781733908.  It can also be defined as a lowered ability of the blood to carry oxygen.  Hematology : clinical principles and applications (3. ed. ed.). Philadelphia: Saunders. 2007. p. 220. ISBN 9781416030065.
  3. 3.  Hemoglobin in red blood cells is an oxygen-carrying protein that binds oxygen through its iron component.  Hemoglobin transports oxygen to most cells in the body for the generation of energy.  When hemoglobin levels are low less oxygen reaches the cells to support the body’s activities
  4. 4. Normal physiological changes in pregnancy  Plasma volume (50%)  Red cell mass ( 18 – 25 % depending on iron status)  Physiologic dilution which is greatest at 32 weeks gestation
  5. 5. WHO definition anemia in pregnancy  Anaemia as defined by the World Health Organization as haemoglobin levels of ≤ 11 g/dl.  UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva, World Health Organization, 2001  HCT < 32% gestation Hb 1st Trimester <11.0g/L 2nd Trimester < 10.5g/L 3rd Trimester < 11.0g/L
  6. 6. prevalence  varies  considerably because of differences in socioeconomic conditions, lifestyles and health-seeking behaviors across different cultures.  Anaemia affects nearly half of all pregnant women in the world:  52% in developing countries  23% in the developed world  UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva, World Health Organization, 2001
  7. 7. Prevalence WHO Global Database on Anemia 2008 Preschool children Pregnant women Non pregnant women during child bearing age world 47% 42% 30% malaysia 32% 38% 30%
  8. 8. classifcation Severity of anemia Hb concentration in pregnant women g/dL Treatment Mild 8 – 11 Oral haematinics or paranteral iron therapy. Moderate 6.0 – 8 Depending on period of gestation < 36 weeks gestation Treat with oral haematinics or paranteral iron therapy. If symptomatic admit to hospital. > 36 weeks gestation Paranteral iron in therapy. Consider blood transfusion. Severe < 6 Blood transfusion with 2 units packed cells.
  9. 9. problems  Anaemia is one of the most prevalent nutritional deficiency problems affecting pregnant women .  Thangaleela T, Vijayalakshmi P. Prevalence of anaemia in pregnancy. Indian J Nutr Diet 1994;31:26-32  The high prevalence of iron and other micronutrient efficiencies among women during pregnancy in developing countries is of concern and maternal anaemia is still a cause of considerable maternal & perinatal morbidity and mortality  Cutner A, Bead R, Harding J. Failed response to treat anaemia in pregnancy: reasons and evaluation. J Obstet Gynecol 1999;suppl.:S23-7  one of the world's leading causes of disability  one of the most serious global public health problems.
  10. 10. Anemia effects
  11. 11. Problems in postpartum period  Uterine Atony  PPH  Mortality ( 20% )  Depression  Emotional instability  Stress  Lower cognitive performance tests
  12. 12. Iron deficiency anaemia:  Requirements in pregnancy : 900 mg  Daily iron requirement in pregnancy : 4mg  2.5 mg/day in early pregnancy  6 – 8 mg/day from 32 weeks onwards  Absorption of iron is <10%, so an average of 40 mg dietary iron is required daily
  13. 13. ? Iron is important  vital for all living organisms because it is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport.
  14. 14. Causes Insufficient intake/ insufficient production ; nutrition , spacing , blood disease Increase loss : bleeding/ hemolysis , infestation , renal disease Increase demand : placenta , fetus , red blood cells expansion
  15. 15. Causes
  16. 16. Causes  Poor nutrition  Deficiencies of iron and other micronutrients  Malaria  Hookworm disease  Schistosomiasis  HIV infection  Haemoglobinopathies are additional factors  Van den Broek NR, White SA, Neilson JP. The relationship between asymptomatic human immunodeficiency virus infection and the prevalence and severity of anemia in pregnant Malawian women. Am J Trop Med Hyg 1998;59:1004-7
  17. 17. symptoms
  18. 18. signs
  19. 19. Ix  FBC FBP Peripheral Blood Smear Reticulocyte count  Serum Ferritin  UFEME , Stool Ova cyst  TIBC , Serum Iron  Hb Electrophoresis if required  Serum Folate /B12 if required
  20. 20. Management
  21. 21. Prevention of Anemia Women should be encouraged to undergo a pre-natal check up for early detection and treatment of iron deficient anemia. Proper spacing between two children ( contraceptions ) Having a well balanced diet rich in iron from adolescence. Regular screening for anemia. Fortification of ready-to-eat food with iron Avoid / Reduce smoking / alcohol consumptions
  22. 22. Management for IDA  Dietary advice : 10 – 15% absorption
  23. 23. management
  24. 24. Iron preparations
  25. 25. Treatment
  26. 26. Treatment  Iron Deficiency Anemia:  Treatment: 60 mg of elemental Fe (iron) orally every 6 to 12 hours (e.g. 2 to 4 times per day)  Prophylaxis: 60 mg of elemental Fe (iron) orally every day.  Recommended Daily Intake  Men: 8 mg elemental Fe (iron) orally once daily  Women: 18 mg elemental Fe (iron) orally once daily  Pregnant women: 27 mg elemental Fe (iron) orally once daily  Lactating women: 9 mg elemental Fe (iron) orally once daily  Parenteral & Oral Iron Products - GlobalRPh
  27. 27. Parenteral indications
  28. 28. Parenteral dosage  Iron Dextran ( Imferon / Cosmofer )  IM  Dose :  0.0442 x ( Desired Hb – Current Hb ) x Weight ( kg ) + 0.26 x Weight ( kg)  Iron Sucrose ( Venofer )  IV  Dose :  Prepregnancy Weight ( kg ) x Target Hb – Current Hb ) x 0.24 + 500mg  Cosmofer can also be given in IV route
  29. 29. Management options : Blood transfusion  Symptomatic anaemia  Hb < 6.0g% at 36weeks /close to delivery  Hb < 10.0g% in Placenta Praevia for elective CS
  30. 30. management  Treat infections  Treat worm infestations : Albendazole 400mg/ Mebendazole 500mg  Treat Schistosomiasis : Praziquantel  Treat Malaria : Chloroquine/Hydroxychloroquine
  31. 31. Management options Thalassaemia Syndromes
  32. 32. Conclusions  Screen anemia in pregnancy at booking  Rule out for thallasemia is necessary  Supplementation with iron  Dietary advice  Noted the contraindications of iron therapy  Continue supplemantation through postpartum until cessation of lactation
  33. 33. Thank you

×