Anemia in Pregnancy

- Hb level less than 10 g/dL

- Causes
o Nutritional – protein, iron, vit B6 & vit B12, Folic acid, ascorbic acid
o Dietry iron needs – 15mg/day
o Iron absorption increase in pregnancy
o Iron absorption influence by:
 Ascorbic acid assist process of iron absorption (reducing agent)
 Gastric acid content (reduced in achlorhydria)
 Protein (reduced in malnutrition)
 Carbohydrate (reduced in high Carbohydrate diet)
 Chronic diarrheal state
 Hookworm
o Reduced maternal iron store d/t demands of the fetus & mother
- Investigation:
o Routine antenatal check up – Hb status at regular interval
o If less than 11 g/dL – further Ix
 FBP – IDA, megaloblastic
 Ser iron, TIBC, Ser Ferritin
 Ser Folate, ser vir B12 in all cases of persistent anemia/
evidence of macrocytosis
 Urine C&S – exclude UTI
 Feces microscopy – ova & cycts
 Hb electrophoresis – exclude hemoglobinopathies
- Management
o Depends on diagnosis of the cause
o Majority d/t nutritional cause
o Prophylactic oral iron & folic acid supplements
o SE of oral iron – gastric irritation & constipation
o Constipation can be resolved by dietry fiber supplement
o If non-compliance/ defective absorption – can give IV

- Sickle Cell Syndrome

o Heterozygous sickle trait (HbAS), Homozygous sickle trait (HbSS),
Sickle cell HbC disease, sickle cell thal
o HbSS – chronic anemia, IV sickling leading to vascular occlusion & t/s
infarction, crises often precipitated by infection & dehydration. Renal
complication are common
o Sickle cell HbC – milder variant, near-normal Hb. H/w may produce
sickling crises during pregnancy
o HbAS – Rarely cause probs unless there are conditions of extreme
anorexia, dehydration & acidosis
o High risk group – black African, Indians, Mediterraneans, Saudi Arabs –
screen
o High rates of miscarriage, preterm labour, fetal loss –
 Reduce by regular blood transfusion to maintain high proportion
of HbA
 During labour adequate hydration at all times, & prevention of
infection (prophylactic antibiotics)
- Thalassaemia
o Alpha & beta- Thal
o Beta-Thal – inability to synthesize b chain, homozygous state will be
severe persistent anemia – in pregnancy need repeated regular
transfusion
o Alpha-Thal – fetus may become hydropic causing pre-eclampsia
o Routine screening – risks carrying child with alpha-thal & referred for
pre-natal diagnosis