Anemia

Flow murmur

Causes -
1. nutritional anemia - IDA(microcytic hypochromic) , b12, folate
2. Infection - TB, chronic inf malaria, hook worm infestation
3. Hemolytic anemia
4. Hypoplastic - aplastic anemia

Latent anemia - Hb above 12gm% but no stainable iron in BM

Hematological changes - blood volume inc by 40

Iron req in preg - 900mg ; 400-fetus , 150 placenta , 500 - mother req, 150 blood loss during
delivery, 300mg is saved due to stop of menstruation , 4-6mg/day and 20-25mg of elemental
iron (in non pregnant 2-4mg/day - which is taken from 10elemental iron) ;

Average iron diet = 20mg of elemental iron ; sufficient for nonpregnant.

Pernicious anemia - B12 def due to lack of intrinsic factor in gastric juice.

Investigation - CBC , Hb percentage , peripheral smear (microcytic/ macr, hypo/normochrmoic

,morphology - spheroctye sickle cell and reticulocyte count = Normal 1% ) Hb indices
Hb <11gm% .
Colour indices - PCV (RBC/100ml of blood = 42-47% ; reduces to 32%)
MCV (volume of one RBC= 70-90ul) ; MCH - 30-36%
IDA - all indices low ; megaloblastic anemia MCHC and MCV increased

Stool examination - occult blood and hook worm

Serum iron ( 60-120ug/100ml )and T iron binding capacity (325 -400ug/100ml)

Hb more than 12 - supplement

Hb less than 11 - therapeutic iron supplements

Ferrous Sulphate (cheap- 200mg tablet TDS ); ferrous fumarate ; ferrous gluconate ;
Carboxy maltose

Ask colour stool - black iron sulphide

Liq iron - black teeth

Pareneteral iron - intolerant to oral; anemia doesn't respond, late pregancny ; non - compliance
Irondextran (Imferon - IM - z technique - stains skin black) ; iron sucrose
s/e - pain at injec, skin , local lymphadenopathy, headache, bachkache, tachycardia,
anaphylaxis , joint pains

Total dose of iron - IV 5 % dextrose 500mg then test dose wait for 10mins - give slowly
over6hrs; mmore anaphylaxis ; severe joint pains

Iron sucrose has no anaphylaxis

Ferric carboxy maltose (FCM)

Duodenum & Jejunum abs in ferrous form, = forms ferritin = certain amount of ferritin is formed
in one day - after absorption = excess absorption of iron is not possible; iron circulates in blood
bound to globulin as transferrin. = stored as ferritin and hemosiderin ; phytates and antacid dec
absorption ; vit C inc absorption.
Patient is very severely anemic - with breathlessness and generaised edema ; hospitalise
patient oxygen -blood transfusion Packed cells 200-250mg IV; slowly to avoid overload to heart
and CCF. MOnitor signs of overload, JVP and tender hepatomegaly - if there are signs of CCF
then digoxin and lasix ; then transfuse blood after 2-3days ; and oral or IM iron preperation

repeat transfusion -
1. Severe anemia in late preg
2. Not responding
3. Aplastic anemia
4. aPH and PPh

Vit B12 - 10inj of 1000ug daily then once every month,100my oral tablet everyday;
Folic acid - 5mg / day

RDA Vit B12 - 1ug/day ; folic 1mg/day

Complication - premature labour inc death rate ; circulator reserve is low ; shock or cardiac
failure; delivery of sev anemic patient; absolute bed rest - transfusion of packed cells; strict
aseptic.