KUHS Essay Discussion

Dr GAYATHRI MS , MBBS, MD AIIMS DELHI, DNB, MRCOG , FMAS

Anaemia in pregnancy
 Scenario
Scenario

30 year old G3P3L3 at 20 weeks of gestation on regular antenatal visit found

to have Hb of 6

What is the most common cause for the anaemia?

List the types of anaemia.

Diagnosis of causes of anaemia in pregnancy.

Management of this patient

What isthe
What is themost
most common
common anemia
type of anaemia

• Iron de ciency anaemia- Most common nutritional de ciency anaemia

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 List the types of anaemia

1)PHYSIOLOGICAL
2)ACQUIRED
• Nutritional anemia
Iron deficiency anemia
Megaloblastic anemia (vitamin B12 and folic acid deficiency)
• Anemia of chronic disease
• Anemia caused by blood loss
Acute (APH, PPH)
Chronic (hook worm infestation, bleeding piles etc.)
• Acquired hemolytic anemia
• Aplastic or hypo-plastic anemia

 How will you do diagnosis of cause of anaemia?

Investigations

Typing of anemia • Serum Iron Studies

Assess severity • Urine R/M, C/S
of anemia • RBC indices
(MCV,MCH,MCHC • Liver/Kidney function tests
• Hb estimation • Stool for Ova/ cyst
,RDW)
• CBC • USG whole abdomen HPLC

Must at 1st ANC

VISIT

IDA vs Thalassemia

IDA Thalassemia
❑Low Hb ❑Low Hb
❑Low MCV ❑Low MCV
❑LOW MCH ❑LOW MCH
❑Low MCHC ❑Normal MCHC
❑Low RBC count ❑High RBC count
❑High RDW ❑Normal RDW

Whatisisthe
What themanagement
managementof of this
this patient?
patient?

Treatment options :

1.Dietary measures
2.Deworming
3.Iron supplementation
4.Blood transfusion

• Here, in this scenario, the POG is 20 week and Hb is 6

• We will start with with IV iron after con rming it is IDA,—and if ine ective shift to blood transfusion
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 Parenteral Iron therapy

❖Iron required (in mg)

• Calculated using Ganzoni’s formula

• (Target Hb – Actual Hb) x 2.4 x Pre pregnancy body weight (kg)

• 1000 mg is added to this to replenish stores

• Target Hb : 14 g/dL

 Parenteral Iron therapy -common preparation

❖Iron sucrose
Maximum 600mg in a 2week, given in divided doses

❖FCM- ferric carboxylate maltose

 Response to Iron Therapy

• Improvement in symptoms

• Improved appetite

• Increase in reticulocyte count after 7-10 days

• Rise in Hb after 2 weeks (0.8-1 g/dl/week)

• Hb reaches normal levels by 6-8 weeks

If no significant improvement seen in 3 weeks , diagnostic re-evaluation needed

 Management of anemia in labour

FIRST STAGE SECOND STAGE THIRD STAGE
▪ Propped up position, ▪Cut short using forceps ▪Active
Oxygen SOS ▪Strict asepsis Management of
▪ Adequate cross Third Stage of
matched blood Labour
▪ Adequate analgesia
▪ Antibiotic
prophylaxis, strict
asepsis
▪ W/F signs of
pulmonary edema
▪ Restrict I.V. fluids