ANEMIA PADA IBU

HAMIL
DEFINISI
• Anemia adalah kondisi ibu dengan kadar haemoglobin (Hb) dalam
darahnya kurang dari 12 gr/dl . Sedangkan anemia dalam kehamilan
adalah kondisi ibu dengan kadar haemoglobin dibawah 11 gr% pada
trimester I dan III atau kadar <10,5 gr/dl pada trimester II .
• Haematocrit < 33%
KLASIFIKASI
• Mild 10.0-10.9 gm%
• Moderate 7-9.9
• Severe <7
• Very Severe <4
Iron Defisiensi
• Deteksi
• RBCs, haemoglobin and haematocrit: below normal.
• Serum iron concentration: below normal (n=125 m g/dl).
• Iron binding capacity: below normal (n=400 mg/dl).
• Transferrin saturation: below normal (n=30%).
• Blood film: microcytic hypochromic anaemia
• Treatment
• Diet: liver, meat, kidney, eggs and green vegetables are rich in iron
• Oral iron therapy: ferrous sulphate or ferrous gluconate 300 mg t.d.s. after
meals. Side effects: nausea, vomiting and constipation
Megaloblastic Anaemia

• It is caused by deficiency of folic acid and / or vitamin B12.

• Investigations:
Blood film: > Macrocytic hyperchromic RBCs. >Hypersegmented neutrophilic nuclei (>5
lobes).
Serum folate level: is low measured by radioimmunoassay.
Bone marrow: abnormal red cell precursors (megaloblasts).

• Daily Requirement:Normal folate requirement is 500 mg /day and a similar amount is

needed during pregnancy so that the daily requirement during pregnancy is 1-
1,5mg/day
• Diet rich in folic acid as liver, kidney and meat
Haemolytic Anaemia
• Serum bilirubin: raised.
• Urine: increased urobilinogen.
• Stool: increased stercobilinogen
• Blood film: shows normocytic normochromic anaemia and;
o Small spherical RBCs in case of spherocytosis.
o Target cells in case of Thalassaemia major.
o Sickling after inducing hypoxia by addition of Na bisulphite in case of sickle cell anaemia
• Electrophoresis: detect type of haemoglobin in haemoglobinopathies.
• Estimation of glucose-6-phosphate dehydrogenase activity.
• Treatment
• Blood transfusion: in acute attacks.
• * Folic acid and iron therapy: may be indicated.
KEBUTUHAN FE ( BESI ) SAAT KEHAMILAN
During pregnancy Total 800-1000 mg extra iron is required

250 mg iron lost during

300 mg for Fetus & 50 mg 400-500 mg for increased delivery
for Placenta red cell mass
220 mg basal losses

Average requirement is 4-6mg/day.

 2.5 mg/day in early pregnancy
 5.5 mg/day from 20-32 weeks
 6-8 mg/day from 32 weeks onwards
SEDIAAN FE