Dymphna Casquejo,RN

ANEMIA IN
PREGNANCY

Dymphna Casquejo,RN
What is Anemia ?
⮚ Anemia is defined as the reduction in circulating
hemoglobin below the critical level. The normal
hemoglobin (Hb) is 12-14 g/dL
⮚ WHO has accepted up to 11 g/dL as the normal
hemoglobin level in pregnancy.
⮚ Therefore any hemoglobin level below
11g/dL in pregnancy should be considered
as TRUE anemia
Hemoglobin is a protein in the
red blood cells that carries oxygen
to the body's organs and tissues
and transports carbon dioxide
from the organs and tissues back
to the lungs. This gives blood a
red color because of the red-
colored compound called HEME.
Dymphna Casquejo,RN
TYPES OF ANEMIA

Dymphna Casquejo,RN
 IRON-DEFICIENCY ANEMIA, IDA
The most common type of anemia in pregnancy & even
more common in women during the reproductive age.
Why? Because of MENSTRUATION – with massive blood loss, iron is also depleted.

Characteristics of IDA:
Microcytic (means the RBCs are small in size)
Hypochromic (means the RBCs are less in color)
means that the red blood cells have less hemoglobin than normal. Low levels of
hemoglobin in the red blood cells leads to appear paler in color. In
microcytic hypochromic anemia, the body has low levels of red blood cells that are both
smaller and paler than normal.
Dymphna A. Casquejo, RN
 Causes of Iron-deficiency Anemia
⮚ Diet low in iron – not consuming sufficient amount of iron-rich
foods
⮚ Heavy menstrual periods – blood loss depletes iron stores
⮚ Unwise weight-reducing programs/ diet regimen – diet may not
include sufficient amount of iron rich foods
⮚ Successive pregnancies - d/t increased blood volume
⮚ Low socioeconomic status (may not be able to consume iron &
Vit.C rich foods due to insufficient financial resources)
⮚ Excessive vomiting due to morning sickness
Dymphna A. Casquejo, RN
 How is iron-deficiency anemia
confirmed?
Serum Iron level under 30  μg/dL (60 mcg/dL to 140 mcg/dL)
Increased Total Iron-Binding Capacity of over 400  μg/dL

Dymphna A. Casquejo, RN
 TIBC or Transferrin is the
main protein in the blood that
binds to iron and transports it to
the liver, spleen and bone marrow
where it is incorporated into
hemoglobin or stored as ferritin.

Dymphna Casquejo,RN
Dymphna Casquejo,RN
 Signs & Symptoms of IDA
⮚ Skin /mucous membrane pallor – low circulating hemoglobin
⮚ Extreme fatigue – Low hemoglobin/less oxygen
⮚ Poor exercise tolerance
⮚ Pica (compulsive craving & eating of substances with little or no
nutritional value in pregnant women)
❑ Because the body recognizes the need for more nutrients. Watch this
for further explanation: https://www.youtube.com/watch?v=DLT95Ls3L68
❑ RLS – Restless Leg Syndrome (itchy, crawly, tingling sensation that
urges you to move your legs)
https://www.youtube.com/watch?v=QAOoK5AdFNc
Dymphna A. Casquejo, RN
 HOW IS IDA PREVENTED?

❑ Advising pregnant women to take prenatal vitamins

containing 27mg of Fe as prophylactic therapy
BUT, if women develop IDA, she will be prescribed 120-
200 mg/day of iron as therapeutic dose
❑ Eating a diet high in iron & vitamins including vitamin C

Dymphna Casquejo,RN
RICH FOODS

Dymphna Casquejo,RN
 NURSING INTERVENTIONS
❖Advise pregnant women to take Iron supplements as prescribed by her doctor
❖Encourage to eat Fe-rich food & take iron on an empty stomach or with fruit
juices/vitamin C for best absorption.
❖Check patient’s reticulocyte count. It should begin to increase almost
immediately (2 weeks) Retic count is an indicator that the bone marrow is
producing new RBCs because reticulocytes are immature or developing
RBCs
❖Encourage to consume high fiber diet & water to prevent constipation
because iron can cause constipation
❖Caution women that FeSO4 turns stool to black; so there’s nothing to worry
❖Assess patient’s tolerance to oral iron preparation & report to the doctor if
not well tolerated; an intravenous iron preparation can be prescribed. (Fe
Sucrose) Dymphna Casquejo,RN
May be given through injection or infusion to
patients with iron deficiency anemia who cannot
tolerate oral iron preparations.

Dymphna Casquejo,RN
FOLIC ACID
DEFICIENCY
ANEMIA

Dymphna Casquejo,RN
FOLIC ACID-DEFICIENCY ANEMIA
Most common type of anemia in:
❑ Multiple Pregnancies
⮚ Increased Fetal demand
❑ With Hemolytic Disease
⮚ Rapid production & destruction of new RBCs
❑ Poor gastric absorption
⮚ Gastric bypass for morbid obesity
❑ Women Taking Hydantoin
⮚ Anticonvulsant that interferes with F.A. absorption

Dymphna A. Casquejo, RN
• WHAT IS FOLIC ACID or VITAMIN B9?
✔One of the B vitamins necessary for the formation of red blood cells
✔Associated in preventing neural tube defects in the fetus
Folic Acid – synthetic form of Vitamin B9 sold as supplements/tablets
Folate – natural sources of Vitamin B9 from foods

Dymphna Casquejo,RN
 What kind of anemia develops in Folic Acid-
Deficiency Anemia?
MEGALOBLASTIC ANEMIA
Abnormally LARGE & IMMATURE RBCs
Assessment finding:
⮚ Elevated Mean Corpuscular Volume – means that the size
of the red blood cells are bigger than normal
⮚ MCV, Mean Corpuscular Volume – represents the
average size of the RBCs
⮚ Apparent or obvious during the 2nd trimester of pregnancy

Dymphna A. Casquejo, RN
 MEGALOBLASTIC ANEMIA

Once full blown:

⮚ It becomes a contributing factor of miscarriage
and/or premature separation of the placenta

Dymphna A. Casquejo, RN
 HOW TO PREVENT FA-DA?
❑ Encourage women to take FA supplements as
prescribed by her physician (400μg/day)
❑ Consume green leafy vegetables, oranges, dried beans
or foods rich in Folate or vitamin B9
❑ Take multivitamins containing Folic Acid

Dymphna Casquejo,RN
 NURSING INTERVENTIONS
❖Advise women planning to get pregnant to begin taking
FA supplements as prescribed by her doctor (400 μg/day)
❖Encourage pregnant women to drink milk high in Folate
❖Encourage to eat Folate-rich foods

Dymphna Casquejo,RN
 END OF
PRESENTATION

Dymphna Casquejo,RN