ANEMIA IN PREGNANCY

PHYSIOLOGICAL CHANGES IN PREGNANCY

ANEMIA
Progressive increase in plasma volume up till 32-34
Lower Hb normal values:
weeks, (50%).
Non-Pregnant 11.5-12 g/dl
Progressive increase in Red Cell mass, although the
Pregnant, change with gestation, but generally 10.5
pregnancy, (25%).
g/dl.
Maximum physiological anaemia occur at 32-34 weeks
Clinical features:
gestation.
Mostly detected on routine testing.
MCV, MCHC stay constant, i.e. dilutional anaemia.
Tiredness.
Progressive fall in platelet count, Low platelets only if
Lethargy.
Platelets are <100 or pathologically reduced count. 5 Dizziness.
10% will be 100-150*109/l
Fainting.
There is 2-3 fold increase in Iron requirements in
pregnancy
Hypercoagulable state.
IRON DEFICIENCY ANEMIA
FOLATE DEFICIENCY ANEMIA
The commonest in
Anemia results if
Second commonest in pregnancy.
Stores are depleted.
pregnancy.
The normal dietary Folate intake is
Increased demand by the
Iron intake is poor.
inadequate to prevent
developing fetus, leads to
Absorption is poor.
megaloblastic changes in the bone
increased absorption and
marrow in 25% of pregnant ladies.
Utilisation is reduced.
increased mobilisation from Demand is increased:
Prevalence varies according to :
stores.
Social class.
Multiple gestations.
IDA is more common in
Nutritional status.
Chronic blood loss.
multiple pregnancies.
Factors increasing the risk of FDA:
Haemolysis.
Blood loss at delivery will
Anticonvulsant therapy.
A lot of patients start pregnancy with
further increase maternal
Haemolytic anaemia.
already depleted stores.
anaemia, so it is not only a
Thalassemia.
Menorrhagia.
problem confined to
Hereditary spherocytosis.
Inadequate diet.
pregnancy period.
Previous recent pregnancies
Conception while breast feeding.

DIAGNOSIS
IRON DEFICIENCY ANEMIA
As it is the commonest, it
is always presumed to be
the diagnosis, but should
always be confirmed.
Changes in the indices as
follows:
MCV reduced.
MCH, MCHC reduced.
Serum iron fall,
<12mmol/l (normally
falls in pregnancy).
Total iron binding
capacity increased,
saturation <15%
indicate anaemia.
Serum ferritin, fall.

FOLATE DEFICIENCY ANEMIA

MCV increased.
Megaloblastic changes in
the bone marrow.
Reduced serum and red
cell folate.

MANAGEMENT
Routine iron supplement, as demand is rarely met by
normal iron intake.
Oral supplementation is not without side effects:
Constipation.
Taste.
Diarrhoea.
Nausia and vomiting.
Alternate routes are available:
IM.
IV.
The maximum rate of rise in Hb is around 1g/dl/week.
Severe anaemia diagnosed in the later stages of
pregnancy may need transfusion.
Preconception advice for all women is to take folate
supplement of 0.4mg/day to reduce the risk of NTD, this
will increase to 5mg/day in cases of previous NTD baby,
or in case of intake of anti-folate medications