Anaemia in pregnancy

Anaemia is one of the most common

disorders affecting humans in the world.
The WHO defines anaemia as
Haemoglobin (Hb)< 11g/dl.
Chronic anaemia results in the sense of
well-being; fatigue, stress, decrease in
work capacity.
Anaemia in pregnancy, is associated with
an increased risk of maternal and fetal
morbidity and mortality.

Physiological changes in
pregnancy
Healthy

pregnancy and puerperium are

associated with a marked physiological
changes in the circulating blood; increase
in blood volume and alteration in the
factors involved in haemostasis.
These changes have relevance to the most
potential and hazardous haematological
problems of pregnancy& delivery.
What are they???

Physiological changes
Blood

volume;

Plasma volume
Red blood mass
Hypervolemia state, modifies the response
to hypotension in the first half of
pregnancy and the blood loss at delivery.
Vaginal delivery;? ml
Caesarean section? ml

Causes
Inadequate

intake of nutrition
Excess blood loss
Abnormal demand
malabsorption

Iron deficiency anaemia

Hb

concentration decrease
MCV
MCH
MCHC
All can be calculated from RBC,
Hb,Packed cell volume.
These tests give basic guide to a
diagnosis in pregnancy.

 MCV,

the most sensitive indicator of

underlying Iron deficiency, decrease
Hypochromia, and MCHC appear with
more severe degree of Iron defiency.
Serum ferritin
Total Iron binding capacity

Management
Confirm

diagnosis;
history, examination and
investigation
Treatment depends on the degree of
anemeia and ?????

Treatment
Nutrition
Iron

therapy, various forms, depends

on
Compliance of the woman
Associated GIT symptoms
Availability of medication
Cost

 Oral

Iron,
ferrous fumerate, ferrous sulphate
Does depends on level of HB
Supplement folic acid
Give proper instructions
Care if on throxine, calcium,

Injectable/ parentral Iron

therapy
Intramuscular
Intravenous

infusion

1.
2.

3.
4.

The following statements about oral

iron prophylaxis during pregnancy
are correct:
Gastric side effects are does-related.
Iron absorption during the first trimester
of pregnancy is decreased compared with
non-pregnant state.
Non-compliance of the mother occurs in
less than 10%.
Oral maternal iron prophylaxis is
recognized to be associated with an
increase in MCV


1.
2.
3.
4.
5.

Iron deficiency anaemia in

pregnancy
MCHC and MCV are low
There is usually chronic blood loss
Blood transfusion is indicated if the
Hb is <9gm/dl.
There is increase risk of Preeclampsia.
There is no proven danger of
teratogencity from Iron therapy.

A clinical scenario
A

25 years old gravida 2with a normal

past obstetric history, is found to have a
Hb of 10gm/dl at 32 weeks of gestation.
The Hb at booking(12 weeks) was
12gm/dl and she has not taken Iron
supplements during this pregnancy. Full
investigation shows a MCH of 32 and a
MCV of 86FL. The blood film shows
some polychromasia and microcystic.

These findings are diagnostic of Iron

deficiency anaemia
2. The MCV is a better guide to the
presence of Iron deficiency anaema
than is Hb level.
3. Should iron deficiency occur late in
a prgnancy, parentral Iron will raise
the hb faster than oral iron
1.

Haemoglobinpathies
Sickle

cell disease
Is the name given to a group of inherited
blood conditions which include:
Sickle cell anaemia,
Sickle cell beta thalasemia,
Haemoglobin SC disease.
The most common and severe is Sickle
cell anaemia

What causes sickle cell

anaemia
Inherited

disorder of the Hb structure

Antenatal care

Sickle cell trait (HbSA) , may have UTI and

microscpic haematuria
Sicle cell anameia
Bad obstetric history
Painful crises
Jaundice
Anaemia
Deformed pelvis Increase rate of operative
deliveries; CS
avascular necrosis of the hip

Diagnosis
Hb

electrophoresis, not specific, Hb

D, G
Sickling test, not specific, HbC Hb
memphis.
Hb solubility test, specific, cheap,
rapid and simple.
reticulocytes

Combination; HbSS and

pregnancy hazardous
Mother

Infection
Anaemia
Heart failure
Painful crises
Embolism/ stroke
Pulmouary hypertension
Renal dysfunction
Retinal disease
Leg ulcers
Choliothesis

Antenatal follow-up
Mother

MSU
Blood pressure
Dip stick
Renal function
Liver function
Complete blood picture
Will they have Iron deficiency anaemia????

Fetal monitoring
USS

for viability <9 weeks

USS, first trimester 11-14 weeks
USS detailed anomaly at 20 weeks
Biometry every 4 weeks.

What to give
Folate,

because ??
Asprin , how much???
Heparin, what kind??

In pregnancy Avoid
Hypoxia
Acidosis
Infection
Dehydration
Stress
Exercise
Extreme

Teperature

Treatment
Multi-disciplenary

approach
Supportive measures
Rehydration
Analgesics
Blood transfusion, keep Hb S level<40%
Keep Hb A level >60%

Further Readings
Management of sickle cell Disease in
pregnancy.Guideline No 61 July 2011
www.evidence.nhs.uk
www.rcog.org.uk/Guidelines

Maternal sickle cell disease

The

spontaneous miscarriage is
increased
The incidence of proteinuric
hypertension increased.
The incidence of spontaneous delivery is
increased.
The incidence of small for gestational
age is unchanged.
The presence of sickle cell disease in the
fetus can not be diagnosed.

Sickle cell disease

There

is failure of formation of the

beta chain of polypeptide.
Hb level rarely fall below 9gm/dl.
Iron deficiency anaemia is usual
Crises is unlikely to occur the trait.

Perinatal mortality rates are

:adversely affected by
Alpha

Thalasemia minor

HbSS
Beta

Thalasmia minor
HbSC
Sickle cell thalasemia
Sickle cell trait