Anemia

Darlin Forbes
DEFINITION
Reduction in circulating Hb mass
< 12g/dl in non-pregnant women
<10 g/dl in pregnant women
CDC
Anaemia in iron supplemented preg.
Woman
Hct 33% & Hb 11g/dl – 1st & 3rd trimester
Hct 32% & Hb 10.5 g / dl - 2nd trimester
WHO grading of anemia
Mild 10g/dl
Moderate 7- 10 g/dl
Severe < 7 g/dl
Hemotological Changes in preg.
Physiological Anemia of pregnancy
Plasma volume s 40-50%
RBC mass s 30 %
As a result Hb concentration decreases by 2g/dl
Decreased Hb concn. Is due to haemodilution
Criteria of Physiological Anemia

1) Hb 10 gm %
2)RBC 3.2 million cells / cu mm
3)Peripheral Smear – Normal morphology
Classification of Anaemia
Classification …….
ERYTHROPOISES
IRON METABOLISM
IRON Requirements during Pregnancy
 Maternal req. Of total Iron -1000mg
 500 mg  Mat. Hb. Mass expansion
 300 mg  Fetus & Placenta
 200mg  Shed through gut urine, skin

DEVELOPMENT OF Iron def. anemia
Iron Deficiency Anemia – 3 stages
 a)Depletion of Iron stores
 b)Iron deficient erythropoiesis
 c)Frank Iron deficiency Anemia
Symptoms of IRON DEFICIENCY ANEMIA
 Fatigue
 Weakness
 Headache
 Loss of appetite
 Dysphagia
 Palpitations
 Dyspnea on exertion
 Ankle swelling
 Paresthesias
 Leukoplakia
Physical examination
 Pallor of varying degrees (Mucous membranes , nail
beds – Koilonychia or Platynychia
 Glossitis
 Stomatitis
 Heart murmurs
 Increased JVP
 Tachycardia
 Tachypnea
 Postural hypotension
 Crepitations- due to lung congestion
Depletion of Iron stores
 Ferritin <20 ng/ml
 Hb / Hct. Normal
 RBC INDICES normal
Iron deficient erythropoiesis

 Ferritin <20 ng/ml
 Transferrin saturation>25%
 Hb –Normal
 Serum Iron < 60mg/dl
c)Frank Iron deficiency Anemia
 ferritin <20 ng/ml
 Transferrin saturation>25 %
 Serum iron <60 mg/dl
 Hb <10g/dl, Hct.<28%
Microcytic Hypochromic
PROPHYLACTIC
 WHO - 60 mg Elemental iron + 400

micro gram Folic acid / day * 6 months
& 3 months postpartum
Iron Supplements
PARENTERAL ADMINISTRATION
 INDICATIONS
1. Intolerance to oral iron
2. Non compliance pt.
3. Inflammatory bowel disease
4. Pt. unable to absorb iron orally
5. Patients near term
MEGALOBLASTIC ANAEMIA
Incidence – 0.2 – 5 %
Caused by folic acid deficiency &

Vit B12 deficiency
Folic Acid Defciency
Pathophysiology
 Preg. Causes 20 -30 fold increase in Folate
requirement (150-450 microgram / day ) to meet
needs of fetus & placenta.
 Placenta transports folate actively to fetus even if

the mother is deficient.
 This cause decreased plasma folate levels.

Causes of Folic acid deficiency
 1.Diet- Poor intake, prolonged cooking.

 2. Malabsorption – Coeliac disease.
 3.Increased demand – Pregnancy, cell proliferation
(hemolysis )
 4.Drugs – anticonvulsants, contraceptive pill,
cytotoxic drugs (Methotrexate )
 5.Diminished storage – Hepatic disorders & Vit C
deficiency
Diagnostic features of Folic acid deficiency
 1.Serum Folate levels – Low <3 ng/ml
 2.Erythrocyte Folate levels - <20 ng/ml
 3.Peripheral smear – Hypersegmented
neutrophils,Oval macrocytes,Pancytopenia
Treatment
 Pregnancy induced megaloblastic anaemia-
Folic acid, nutritious diet & Iron .
 Supplementation of 1mg of folic acid daily can improve
MA by 7 to 10 days
 Folic acid should be given with iron
 Ascorbic acid 100mg Tid enhances action
In other conditions
 Recommended folic acid dose – 5mg /day orally daily
Prophylaxis
 WHO – 400 micrograms folic acid daily to prevent
neural tube defects
Vit – B12 Deficiency
Pathophysiology
 Vit B12 absorption is unaltered during pregnancy
 Tissue uptake is increased  Decreased serum B12
 Recommended B12 intake – 3 microgram /day.
CAUSES of Vit B12 def.

 Strict Veg. diet
 Use of proton pump inhibitors
 Metformin.
 Gastritis
 Gastrectomy
 Ileal bypass
 Crohn’s
 H. Pylori infection
GASTRIC
ATROPHY ?
autoimmune
Pathogenisis Reduced IF
of secretion
PERNICIOUS Gastric juice IF
Antibody
ANEMIA 
Failure of
absorption of
dietary Vit B12
Deficiency of
Vit B12
Clinical manifestations
 Macrocytic Megaloblastic Anemia

 Glossitis
 Peripheral neuropathy
 Subacute combined degeneration of the Spinal cord
 DIAGNOSIS
Ser.Vit B12 levels ,100 pg /ml
Radio active Vit B12 absorption test . ( Schilling Test )
Treatment
 1000 microgram parenteral cyanocobalamin every
wk * 6 weeks
 Pernicious Anaemia – Oral Vit B12
 Total Gastrectomy – 1000 microgram Vit B12 im
every month.
 Partial gastrectomy – Ser. Vit B12 levels measured.
ANAEMIA ASSOC. WITH CHRONIC INFECTIONS / DISEASE
 Common in developing countries

 Poor response to Haematinics unless primary cause is
treated
 Worm infestations is common ( Diagnosed by stool
examination )
 Urinary tract inf, & asymptomatic bacteriuria in preg.
Is assoc. with refractory anaemia
 Chronic renal disorders = due to erythropoietin def.
 Treated with recombinant Erythropoitin
Acquired hemolytic anemia
 AUTOIMMUNE HEMOLYTIC ANEMIA
 AUTOANTI-BODIES OF iGg OR WARM
ANTIBODIES AGAINST Red cell antigens, causes
premature destruction of RBC”s
 ETIOLOGY
 Lymphomas,Leukemias , Connective tissue diseases,
Infections , Chronic. Inflammatory diseases & drug
induced antibodies
Diagnosis
 Direct Coomb’s Test
 Blood smear – Spherocytosis & Reticulocytosis
TREATMENT
 Prednisone 1mg / kg / day orally
 Azathioprine
 Splenectomy
Effect of anaemia in preg.
In MOTHER
During preg.
 Pre eclampsia
 Infectuion
 Heart failure
 Pretem labour
Labour
Uterine inertia
Postpartum Haemorrhage
Cardiac failure
Shock
Puerperium
Puerperal sepsis
Subinovulation
Failure of lactation
Puerperal venous thrombosis
Pulmonary embolism
Fetus
 Amount of iron transferred to fetus is unaffected
even if mother is in iron deficient state
 Prematurity
 Low birth weight babies
 Intra uterine deaths due to severe maternal
anoxemia
Pt. with
Anemia
DIAGNOSIS OF Hb<11, Hct
ANEMIA <0.33
DURING
Investigations-
PREGNANCY MCV, PS ,Retic
count
MCV <80 Low MCV 80 – 90 MCV >99

PS –Microcytic PS – Normal PS-Macrocytic
Serum RETIC RETIC – Ser.B12 &

Iron COUNT NORMAL /
studies INCREASED DECREASED Folic acid levels
Serum Iron reduced -Hemolytic Folate < 3ng/ml

TIBC-Increased Ser.
-Hemoglobin Drugs Vit B12 <80pg/ml
Ferritin – reduced
opathies Bone marrow
-Autoimmune path.
Cases Chronic
Therapy with
- Drug induced diseases
IRON DEF ANEMIA 1 mg/day – Folate
TREATMRNT WITH
ORAL / 1000ug im B12 every wk *
PARENTERAL IRON 6 wks foll by every month

Anemia

Uploaded by

Copyright:

Available Formats

Anemia

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Anemia

Uploaded by

Copyright:

Available Formats

Darlin Forbes

Criteria of Physiological Anemia

 Maternal req. Of total Iron -1000mg

 500 mg  Mat. Hb. Mass expansion

 300 mg  Fetus & Placenta

 200mg  Shed through gut urine, skin

Iron deficient erythropoiesis

 WHO - 60 mg Elemental iron + 400

Caused by folic acid deficiency &

 Placenta transports folate actively to fetus even if

 This cause decreased plasma folate levels.

 1.Diet- Poor intake, prolonged cooking.

CAUSES of Vit B12 def.

 Macrocytic Megaloblastic Anemia

 Common in developing countries

MCV <80 Low MCV 80 – 90 MCV >99

Serum RETIC RETIC – Ser.B12 &

Serum Iron reduced -Hemolytic Folate < 3ng/ml

You might also like