tags:
- o&g/obsAnemia in Pregnancy
Anemia is the commonest hematological disorder that may occur in pregnancy.
Hb ≤11g/dL [WHO]
1st trimester: <11 g/dL
2nd trimester: <10.5 g/dL
3rd trimester: <10 g/dL
Mild: 9.0 - 11.0
Moderate: 7.0 - 9.0
Severe: <7.0
Estimation >40% of pregnancies are complicated by anemia [WHO]
Malaysia - 12% in 1st trimester, 32% in 2nd trimester, 43% in 3rd trimester
Physiological
Iron deficiency
Folic acid deficiency
Vit B12 deficiency
APH
Chronic hookworm infestation
Thalassemia
Autoimmune hemolytic disease (AIHA, SLE)
Sickle cell disease
Hypothyroidism
Chronic renal disease
Higher increase of plasma volume compared to RBC volume
RBC becomes diluted -> hemodilution
Increased demand of iron during pregnancy
Iron deficiency -> ↓ serum iron, ↑ TIBC -> negative iron balance
Anemic symptoms:
Palpitation
SOB
Dizziness
Presyncopal attack
Lethargy
PPH
Cardiac failure during labour
Subinvolution
Pulmonary embolism
IUGR
Neural tube defect (folate deficiency)
Intrauterine death
Dietary intake
Supplement - folic acid, vit B12
Family h/o thalassemia
APH
h/o anemia - pre-pregnant & prev pregnancy
h/o blood transfusion
Palm & nail bed - pale
Conjunctival pallor
Tongue - pale, glossitis (chronic IDA)
Booking
24-28 weeks
36 weeks
FBC - to identify the severity, type of anemia
Mentzer index - MCV/RBC (<13 likely thalassemia, >13 likely IDA)
FBP & peripheral blood smear - TRO thalassemia or sickle cell
UFEME
Iron studies - TIBC, serum iron/ferritin
Serum folate/B12 (if required)
Stool ova cyst - if suspected hookworm infestation
Iron rich food: spinach, saltwater fish, meats, seafood
Iron absorption enhancers: vit C
Iron absorption inhibitors: coffee, tea, polyphenols, eggs, milk
Prophylaxis: 100mg/day elemental iron + 5mg folic acid
Treatment: 180mg/day elemental iron + 5mg folic acid
| Preparation | Elemental iron (mg/tablet) |
|---|---|
| Obimin | 30 ferrous sulphate |
| Ferrous fumarate | 60 ferrous fumarate |
| Iberet | 105mg ferrous sulphate |
| Zincofer | 115mg ferrous sulphate |
| Maltofer | 100mg ferric hydroxide polymaltose |
Indications:
insufficient/no response to oral iron
severe anemia
insufficient absorption of oral iron
intolerance of oral iron
poor compliance
| Parenteral iron | Route of administration | Elemental iron (mg/mL) |
|---|---|---|
| Iron dextran (Cosmofer) | IM or IV | 50 |
| Iron sucrose (Venofer) | IV | 20 |