ANAEMIA IN PREGNANCY

Klinik Kesihatan Ibu Dan Anak

Parit Buntar
 CASE 1
• Name : Puan A
• Age : 39years old
• Race : Malay
• Occupation : Pembantu Tadbir
• Gravida :6
• Para : 3+2
• Tagging : Yellow
 PROBLEM LISTS
1) GDM on diet control
• MGTT : 54.0/8.1 ( at 28 weeks poa)
• Hba1c : ?
• BSP good control
2) B-thalassemia trait
• Booking Hb 8.7 g/dl, Hb at 36 weeks 7.7g/dL
• Postnatal Hb (1 month postpartum:9.2g/dL)
• TIBC 65.7, iron 21.3, ferritin 53.9
3) History of miscarriage on 2012 and 2014-D&C
done.
 Antenatal History
Date POG Details Plan
12/12/19 9w6d Booking done in KKIA Parit Buntar 1) T.Hematinic I/I od
BP: 110/70, PR 82, Urine albumin: neg 2) For anaemia work out
Hb 8.7 g/dL, MCH ?, MCV ?
(MO) Wt: 60(BMI: 25.6)

TAS: CRL 10w2d,FH seen, Folow EDD on

10/7/2020

26/12/19 12w Hb 8.5 (on T.Ferrous Fumarate I/I od) 1) Rujuk PSP 16/1/2020
2) Pemakanan seimbang
SN
9/1/2020 14w Hb 8.5 1) Pemakanan seimbang

SN

23/1/2020 15w6d Hb 7.8 (not compliance to hematinic) 1) Nasihat pemakanan tinggi

Asymptomatic anemia zat besi diberi
Serum iron study taken 2) Change to T. iberet 1/1/OD.
SN 3) Refer FMS on 26/2/2020
Seen by PSP- counselling on anemia given
 Date POG Details Plan
6/2/20 18w Hb 8.3 1) Nasihat pemakanan
diberikan-ibu dapat
SN menerangkan
makanan tinggi iron

20/2/20 20w1d Hb 8.1 (compliance to T. iberet 1/1OD) 1) Nasihat pemakanan

Asymptomatic anemia tinggi zat besi ,
SN & serum iron 21.3, bahaya anemia
MO TIBC 65.7 , Ferritin 53.9 2) Komplikasi anaemia
3) Continue T. Iberet 1/1
TAS: parameter at 20w 1d, FH seen, OD
placenta posterior not low lying

26/2/20 21w B-thalassemia since 2006,Husband normal 1) Cont T. Iberet 1/1 OD

Compliance to T. iberet 1/1OD + T. ferrous Fumerate
FMS Asymptomatic anemia 400 mg OD
2) TCA FMS 29/4/2020
3) Counsel regarding
thalassemia.
4) Reinforce regarding
compliance.

11/2/20 20w1d Hb 9.5 1) ↑T.Ferrous Fumarate

III/III od
KKJB 2) Nasihat cara
 Date POG Details Plan
5/3/20 23w3d Hb 7.9 (compliance to T. Iberet 1/1od and t. 1) Nasihat mengenai
ferrous fumerate 400 mg od)) anemia dan cara
SN & mengatasi
MO No anaemic symptom diterangkan.
2) Cont t. iberet 1/1 od +
t.ferrous fumerate
400mg OD
19/3/20 24w Hb 8.0 1) Nasihat pemakan
SN tinggi iron diberi

30/3/20 25w4d Hb 7.8 1) Nasihat pemakanan

SN tinggi iron diberi
13/4/20 27w2d Hb 7.8 (compliance to t. iberet I/I OD + 1) Nasihat cara
t.ferrous Fumerate 400 mg OD) pemakanan
MO hematenik diberi
2) Refer combine clinic
for share care- discuss
with DR Lui- no need
to refer, cont FMS
follow up and to refer
stat if Hb <7.
 Date POG Details Plan
21/4/20 28w3d TAS: parameter correspond to date, AFI 16.1, 1) Rpt scan at
PUS, FH activity seen 32weeks
MO

27/4/20 29w2d Hb 7.5 1) Nasihat pemakan

Asymtomatic anemia hematenik dengan
SN & pale betul
MO 2) FKC
3) Cont T. Iberet
1/10d+ t. ferrous
Fumerate 400 mg
OD
29/4/20 29w5d Newly diagnosed GDM MGTT 4.1/8.10 1) BSP in 2/52
Asymptomatic anemia 11/5/2020
FMS Mild pallor 2) TCA to review BSP
12/5/2020
3) Refer PSP (for
counselling via
phone)
4) TCA FMS 3/6/2020
 Date POG Details Plan
12/5/20 31w3d Hb 7.9 1) Cont T. iberet 1/1OD
Asymptomatic anemia and T. ferrous
SN Fumerate 400 mg OD

18/5/20 32w1d Review BSP: 6.6/5.1/5.1/6.5 1) Repeat scan at 36

TAS: parameter correspond to date, AFI 15.1, weeks
PUS, FH activity seen, cephalic 2) Bsp on 27/5/2020
(MO) Asymptomatic anemia 3) Cont T. iberet 1/1OD
Compliance to T. iberet 1/1od and T. ferrous and T. ferrous
Fumerat 400 mg OD Fumerate 400 mg OD

28/5/20 33w6d Review BSP 5.1/5.8/5.9/6.4 1) Repeat BSP 2/52-

MO 10/6/2020
2) Next scan at 36/52

29/5/20 34w Hb 8.8 1)FKC

SN 2)Cont BSP
 Date POG Details Plan
3/6/20 34w3d 1) TCA FMS 2/12
Compliance to T. iberet 1/1 OD and T. postnatal
FMS Ferous fumerate 400 mg OD 2) Not allow post date
Asymptomatic anemia 3) Cont medication
@20weeks @ 32 weeks 4) TCA if sym of labour
Serum iron 21.3 →28.0
TIBC 65.7 →76.3
Serum ferritin 53.9 →87.9

9/6/20 35w4d Hb 7.7 1) FKC

2) Nasihat kepentingan T.
SN iberet 1/1 OD and T.
ferrous Fumerate 400
mg OD.
10/6/20 35w5d Asymptomatic anemia 1) Cont T. Iberet 1/1OD
BSP well controlled.- 4.9/5.1/4.5/5.3 and t. ferrous fumerate
MO TAS: cephalic, FH activity seen, parameter 400 mg OD
correspond to date, AFI 10 2) BSP on 29/6/2020
 Date POG Details Plan
23/6/20 37w4d Hb 7.9 1) Cont T. iberet 1/1 OD
Asymptomatic anemia and T.ferrous Fumarate
SN & 400 mg OD
MO TAS: cephalic, PUS, AFI 13, Fh activity 2) Tca stat if symptom of
seen, parameter correspond to date. labour or anemia
3) Not allow post date
1/7/20 38w5d BSP 4.8/5.2/4.6/5.5 1) Cont medication
2) FKC
SN & 3) TCA if symptom of
MO labour or reduce FM

2/7/20 38w6d Delivered baby boy Bwt: 3.45kg via SVD

in hospital Taiping.

Postpartum HB 9.2, MCV 72.5, MCH 23.5

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