Approach to anemia with pregnancy

By
Almaza ALI
Msc family medicine, MD family medicine, Professional diploma of infection control
Tel/ 01224498153
Email /almazasalim@yahoo.com
MCQ
1-Pregnant woman is considered anemic when her Hb is below
(unit gm/dl)
A. 12 B. 11 C. 10 D. 9
2-Most common cause of anemia in pregnancy is
A. Nutritional anemia B. Aplastic anemia
C. Thalassemia. D.Hemolytic
3- Response to anemia management by oral Fe therapy in
pregnancy can be assessed earliest
A. Increase in Hb% B. Increase in reticulocyte count
C. CBP D. Increase in S ferritin
Learning Objectives
• How to diagnose anemia in pregnancy
• Effect of anemia on mother & fetus
• prevention of anemia during pregnancy
• supplementation of oral iron during pregnancy
• Management of anemia during pregnancy.
Definition of anemia

A condition where circulating levels of Hb are quantitatively or

qualitatively lower than normal

Non pregnant women Hb < 12gm%

Pregnant women (WHO) Hb < 11 gm% Haematocrit< 33%

Pregnant women (CDC)

1st&3rd Trimester Hb <11 gm%

2nd trimester Hb < 10.5 gm%

Iron requirements during pregnancy

During pregnancy Total 800-1000

mg extra iron is required

250 mg iron lost

300 mg for Fetus 400-500 mg for during delivery.
& 50 mg for increased red cell
Placenta mass 220 mg basal
losses
 Causes of anemia during pregnancy
Nutritional / Iron deficiency anemia
Pre-pregnancy poor nutrition
Besides Iron, folate and B12 deficiency also important
Chronic blood loss due to parasitic infections
Multiparity and multiple pregnancy
Acute blood loss
Recurrent infections (UTI) - anemia due to impaired erythropoiesis
Hemoglobinopathies like Thalassemia, sickle cell anemia and
Aplastic anemia
Patho-physiology of anemia during pregnancy

Augmented erythropoiesis in pregnancy.

Blood volume increases 40-45% in pregnancy.
Increase in plasma is more as compared to red
cell mass leading to hemodilution &low Hb level.
Iron stores are depleted with each pregnancy.
Un-spaced and multiple pregnancies result in
higher prevalence of iron deficiency anemia.
 Effect of Anemia on Pregnancy & Mother

 Higher incidence of pregnancy complications(abruptio

placentae, preterm labor).
 Predisposed to infections like UTI, puerperal sepsis.
 Increased risk to PPH .
 Sub involution of uterus.
 Failure of lactation.
 Maternal mortality – due to CHF, Cerebral anoxia, Sepsis
and Thrombo-embolism.
 Effect of anemia on fetus and neonate

Higher incidence of abortions, preterm birth, IUGR

IUD
Low APGAR score at birth

Neonate more susceptible for anemia & infections

Higher Perinatal morbidity & mortality
Anemic infant with cognitive & affective dysfunction
work up of anemia during pregnancy
the aim of investigation to assess:-
Severity of anemia :- Hb & Haematocrit, at first visit,
28-30 weeks & 36 weeks
Type of anemia :-CBP will detect microcytic,
macrocytic, normocytic, hemolytic, pancytopenia
Bone marrow activity:- reticulocyte count (N .2-2%),
higher in hemolytic anemia
Cause of anemia :- serum iron, ferritin, trans-ferritin
binding capacity(TIBC),HbA2,stool analysis,
BUN ,chest x ray.
 Prevention of Iron deficiency anemia

• encourage diet rich in iron as • Heme iron better, present in

fruits and vegetables. animal food & is better

• Treat worm infections and absorbed

maintain general hygiene • Iron absorption enhanced by

citrous fruits and Vit C. Avoid
• Food fortification with iron.
tea, coffee, Ca, phytates,
Iron & folic acid
phosphates, oxalates, egg,
supplementation in young girls
cereals with iron
& during pregnancy
 Iron supplementation in Pregnancy‫م‬
• 40-60 mg elemental iron & 400 ug of folic acid required daily
in non anemic during pregnancy and 3 months after labour.
• In anemia therapeutic doses are 180-200 mg /d in divided
doses.
• Route of administration depends on severity of anemia,
Gestational age,compliance & tolerability of iron.
• Iron preparations included:- fumarate, gluconate and sulfate.
• side effects include:- GIT upset, diarrhoea and constipation.
• Iron supplementation not recommended during first trimester due
to:-Higher incidence of miscarriage and birth defects.
– Bacterial infection (bacteria grow after taking iron from
supplementation)
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