1. ANAEMIA IN PREGNANCY

2. INTRODUCTION:
• Anaemia is the commonest
medical disorder in pregnancy
• It is responsible for 40-60% of
maternal deaths
• It causes direct & indirect
deaths;CHD,H-ge,Infection,PE
• It increases PNM;PTL,IUGR, low
iron stores & iron def. anaemia.

3. Factors required for
erythropoiesis:
• Proteins ; Erythropoietin
• Minerals; Iron
• Trace elements; Zinc,cobalt
• Vitamins;Folic acid,B1+6+12,C
• Hormones;Androgenes & T4
• Also;Vit A(cell growth),Zinc-
needed for protein synthesis

4. DEFINITION:
• A condition of low Hb,lying at
two standard deviations below
the median of a healthy
population of the same age,sex
and stage of pregnancy.
• Cut-off ; for WHO= < 11g/dl and
PCV < 0.33.
For USA= < 10.5g/dl, during the
second trimester

5. SEVERITY OF ANAEMIA
CATEGORY SEVERITY Hb lev.(g/dl)
I Mild 10.0-10.9
II Moderate 7.0-10.0
III Severe < 7.0
IV V.severe(de
compensat.)
< 4.0

6. Prevalence of Anaemia:
• Globally = 40%
• It is <20% in Europe up to >80% in the
Indian sub-continent.
• IDA is the commonest type
• The balance between the iron ingested and
lost dictates the iron nutritional status!
• Food iron =provide 6mg/1000 calories
• There are Haem & non-haem pools;
• Haem absorption = 15-50%,not affected by
inhibitors. Non-haem absorption-- is
increased by enhancers & decreased by
inhibitors.

7. Classification:
1. Iron deficiency
2. Megaloblastic–folic acid, vita
B12 ( uncommon)
3. Haemolytic(infection, malaria)
4. Haemoglobinpathies; Sickle-
cell, Thalathaemias.
5. Aplastic

8. • Factors affecting the Iron status
IRON ABSORPTION IRON LOSS
Enhancers:
Haem iron, proteins,
meat,vit C, alcohol
fermentation, gastric
acidity,ferrous iron,
low iron stores, high
altitude,haemolysis.
Inhibitors:
Phytates, calcium,
tannins, tea & coffee,
Physiological :
Losses from skin and
intestines, delivery,
lactation, menses.
Pathological :
Hookworm and others
H-ge from GIT
Allergies

9. Iron bio-availability:
• I] Low ; simple,routine diet of
cereals,maize,rice,beans etc. + negligable
amounts of meat,fish and vit C.low
absorption[3-4%].
• II] Intermediate ; include some animal
foods.
• III] High ; rich in animal foods + generous
amount of vit C.
IRON REQUIREMENTS :
Vary with maternal body weight and the
maturity of the fetus; 2.5 mg/d in early
pgy,5.5mg/d in 20-32/52,6-8mg/d from 32/52
Absorption < 10%; so iron suppl.is needed.

10. Investigations:
• Aims: at finding; Degree, Type and Cause
of anaemia.
• Hb, Red cell count, PCV.
• Peripheral blood smear ; Micro-, Aniso-, and
Poikilocytosis.
• Haem Indices; MCHC--most sensitive.
• Anaemia: Hb<10gm%,RedCC< 4mln/mm³
PCV< 30%,MCH< 30%,MCV< 75µm³, and
MCH< 25pg.
• Others: Serum Fe< 30µg%, TIBC> 400µg%,
Saturation< 10%,Ferritin< 15µg/L. Stools,
Urine, Bone marrow study (not routinely).

11. CAUSES OF IRON DEFICIENCY:
1.Diet; habits, poverty, food fadism = when some types of food
is not allowed due to customs !
2.Worm infestation; Amoebiasis and Giardiasis.
Shistosomiasis.Malaria. Excessive sweating and piles.
3.Multiple pregnancies.
PREVENTION:
1.Prophylaxis of non-pregnants; giving them 60mg of iron daily
for 2-4/12.
2.Iron supplementation during pgy ;
WHO--- 60mg Fe + 250µg Folic acid 1-2/day,
2-3 inj. Of Imferon 250mg IM monthly.
3.Trt of hookworms; Albendazole 400mg/d or Mebendazole
100mg twice/d for 3 days.
4.Improvement of dietary habits.
5.Social services; education, personal hygiene ,
sanitation and alleviation of poverty.
6.Food fortification; of fish sauce,sugar,curry powder & salt
with ferrous sulphate,gluconate,fumarate or succinate or
chelated iron [bovine Hb concentrate and Fe-Na-EDTA].

12. TREATMENT
• Accurate diagnosis of anaemia.
• Admission: 1)Hb<7gm%.2)Other associated
medical condition.
• Choice of therapy depends on: a)Severity.
b) Duration of pgy. c) Associated factors.
• Options:1)Oral Fe.2)Parentral. 3)Blood
transfusion.
• TDI & Exchange blood transfusion to be
used in certain circumstances.
• Expected rise of Hb is 0.7-1gm/week.
• Folic acid is added in most cases. Anti--
biotics & Anti-helminthics may also needed