anemia in pregnancy
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Anaemia in PregnancyTRANSCRIPT
Anemia in
pregnancy
Update 1/11/2014
Juliana Mohd Basuni
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.
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
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
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
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
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%
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.
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 anaemiais 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.
Anemia effects
Problems in postpartum period
Uterine Atony
PPH
Mortality ( 20% )
Depression
Emotional instability
Stress
Lower cognitive performance tests
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
? Iron is important vital for all living organisms because
it is essential for multiple metabolic
processes, including oxygen
transport, DNA synthesis, and
electron transport.
Causes
Insufficient intake/ insufficient production ; nutrition , spacing , blood disease
Increase loss : bleeding/ hemolysis , infestation , renal disease
Increase demand : placenta , fetus , red blood cells expansion
Causes
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
symptoms
signs
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
Management
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
Management for IDA
Dietary advice : 10 – 15% absorption
management
Iron preparations
Treatment
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
Parenteral indications
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
Management options : Blood
transfusion
Symptomatic anaemia Hb < 6.0g% at 36weeks /close to delivery
Hb < 10.0g% in Placenta Praevia for elective CS
management
Treat infections
Treat worm infestations :
Albendazole 400mg/ Mebendazole500mg
Treat Schistosomiasis : Praziquantel
Treat Malaria :
Chloroquine/Hydroxychloroquine
Management optionsThalassaemia Syndromes
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
Thank you