ANEMIA

DEFISIENSI
BESI PADA
KEHAMILAN
Amri Ashshiddieq
1310211145

INTRODUCTION
Anemia is a reduction below normal in the oxygen-carrying capacity of the blood as

reflected by the hemoglobin or hematocrit values.

Women are at higher risk because of menstrual blood loss.

The Centers for Disease Control and Prevention (CDC) (1998) defined anemia in iron-

supplemented pregnant women using a cutoff of the 5th percentile

11 g/dL in the first and third trimesters, and
10.5 g/dL in the second trimester

Approximately15% to 25%of all pregnancies experience iron

deficiency

ETIOLOGY
lack of iron in the diet as

(a result of not eating enough iron-rich foods or

the bodys inability to absorb the iron being consumed)
Pregnancy itself

because the iron being produced is needed for the womans body to increase
her own blood volume

RISK FACTOR
Age
Parity
Education
Socioeconomic status
History of bleeding
Worm infestation
Period of gestation
Knowledge regarding anemia in pregnancy
Food selection ability
Compliance to iron suplementation

CLINICAL FEATURES OF ANAEMIA IN PREGNANCY

Symptoms
Weakness

Signs
Pallor .

Lassitude , tiredness , exhaustion

Glossitis .

Indigestion

Stomatitis .

Loss of appetite
Palpitation
Breathlessness

Giddiness / dizziness

Oedema
Hypoproteinaemia .
Soft systolic murmur in mitral
area due to hyperdynamic
circulation
Fine crepitations at lung bases.

Swelling feet eye lids ( peripheral

Pale nails . Platynaechoea .
)
Koilonaechia
Generalized anasarca.

Tenderness in sternum .

Blackouts in front of eyes on

sudden standing

Hepatic splenic enlargement .

Symptoms of congestive cardiac

failure

EFFECTS
OF ANAEMIA ON PREGNANCY
.
Maternal
Foetal
Weakness

Preterm baby

Lack of energy

Small for gestation

Fatigue
PET

Increased perinatal morbidity and

mortality

Poor work performance

Palpitation
tachycardia
Even mild bleeding in APH or PPH
can endanger the life
Breathlessness
Increase cardiac output
Cardiac decomposition
Cardiac failure
Increased incidence of preterm
labour
Sepsis

Iron deficiency
Cognitive and affective
dysfunction in the infant
Increased incidence of diabetes
and cardiac disease in later life

DIAGNOSA

KRITERIA ANEMIA

 daily oral supplementation with

30 to 60 mg of elemental iron and 400 g of folic acid is

recommended
in pregnancy (Pena-Rosas, 2012; World Health Organization, 2012).
Anemia resolution and restitution of iron stores can be accomplished with

simple iron compounds

ferrous sulfate, fumarate, or gluconate

that provide about 200 mg daily of elemental iron

PROPHYLAXIS--- Extra iron requirement in pregnancy can be met with balanced diet

rich in iron containing food . Avoid food containing Phytates , tannins

(tea coffee)known inhibitors of iron absorption

4-6mg elemental iron if absorbed / day during 2 nd and 3rd trimester

( over period of 1oo days ). Average daily requirement of absorbed

iron is 4m., beng2.5 mg/day in early 1/2 , 5.5mg/day during 20- 32
weeks and 6-8mg / day 1fter 32 weeks onwards of gestational period.

Indian Government has recommended to prescribe Tab Ferrous

sulfate 100mg + 500ug Folic acid / day for 100 days .

As hook worm infestation is common ,

400mg single dose Albendazole or

Mebendazole 100mg B.D. for 3days therapy
is also recommended.

FOLATE DEFICIENCY ANAEMIA -- Folic acid is needed in higher doses during pregnancy because

of the increased cell replication , taking place in fetus , uterus

and bone marrow.

800 ug is required / day , but pre existing deficiency is common

especially in developing countries . It is mainly due to

inadequate diet / intestinal malabsorption( sprue ) syndrome .

More common in twin pregnancy , multigravida , hook worm

infestation , GIT diseases , bleeding piles , Haemolytic

conditions , malaria and other infections .

Anti folate medications like anti epileptics , anti cancer .

Combined iron and folic acid deficiency anemia is common in

developing countries.

FOLIC ACID DEFICIENCY ANAEMIA - Symptoms

Asymptomatic , loss of appetite, vomiting ,

diarrhoea, unwell with unexplained fever
Signs
Pallor Bleeding points on skin , Enlarged spleen and liver and
neuropathy.
Maternal complications PIH, Abruptio placenta .
fetal complications Folate deficiency in mother can cause fetal
neural tube defects , abortion , IUGR, premature / small for date
fetus and poor folate level in newborn .

DIAGNOSIS OF FOLIC ACID DEFICIENCY ANAEMIA

Characteristics

Normal range

Folic acid deficiency

Hb

11-15gm%

<11 gm%

MCV

75-96

> 96

Mean corpuscular HB

27 - 33

33

Mean corpuscular HB
Conc.

32-35

Normal

PBF

Normocytic
Normochromic

Megalobastic , neutropenia ,
thrombocytopenia,
hypersegmentation of
neutrophills

Serum Folate

>3

<3

Red cell Folate

>150 ng / ml

< 150

Serum Iron

60-120 ug/dl

Normal

Serum lactate
dehydogenase
HomoCysteine

Increased
Increased

TREATMENT
WHO recommends 800ug / day in pregnancy and 600ug / day

during lactation period .

To meet this need pregnant and lactating women should be encouraged

to eat more green leafy vegetables ( palak , maithi , baithali , brocoli )

and offal ( liver and kidneys .

Treatment for patient with Folic acid deficiency anaemia should take

5mg folic acid / day for > 4 weeks .

Response is observed by fall in LDH level in 3-4 days and

increase in reticulocyte count in 5-8 days.

CYANOCOBALAMIN (VIT .B12

) DEFICIENCY
A rare cause of anaemia in pregnancy . , as daily requirement of

3ug is easily met with a normal diet .

Pernicious anaemia due to absence of intrinsic factor , resulting in

decrease absorption of Vit B12 is rare in pregnancy ., as it usually

causes infertility.

Clinical findings are same as in folic deficiency .

Vit B12 level is lower in the blood ( < 90ug / L) Deoxyuridine test

can differentiate in two .

Parenteral Vit B12(cynocobalamin ) 250ug / month is the treatment.

Gastric mucosal atrophy following long term use of H2 inhibitor and

Proton pump inhibiting anta acid will result in deficiency of intrinsic

factor and decreased absorption of Vit B12 .

MEGALOBLASTIC ANAEMIA PBF

AND BONE MARROW

REFERENCE
Anemia in Pregnancy, Prof. M.C.Bansal.
Hindawi Publishing Corporation Journal of Pregnancy Volume 2012, Article

ID 630519, 10 pages doi:10.1155/2012/630519

http://americanpregnancy.org/
Netter's Obstetrics and Gynecology
Williams Obstetrics 24th Ed