Anemia in Pregnancy
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Questions and Answers

Which of the following is NOT a characteristic of folic acid deficiency anemia?

  • Hypersegmented polymorphs in leukocytes
  • Increased reticulocyte count
  • Decreased hemoglobin level
  • Increased plasma folate level (correct)

    • What is the recommended folic acid supplementation for all pregnant women?

  • 600 μg/day
  • 200 μg/day
  • 400 μg/day (correct)
  • 100 μg/day

    • Which laboratory finding is indicative of vitamin B12 deficiency compared to folate deficiency?

  • Increased plasma folate level
  • Decreased blood chemistry vitamin B12 level
  • Increased reticulocyte count
  • Normal urinary FIGLU levels (correct)

    • Which condition should be treated if associated with anemia?

    <p>Ankylostoma infestation</p> Signup and view all the answers

    What is the folate requirement increase for normal pregnancy compared to non-pregnant adults?

    <p>200-300 μg/day</p> Signup and view all the answers

    Which blood index typically shows decreased levels in the context described?

    <p>Serum ferritin</p> Signup and view all the answers

    What is the recommended daily dosage of elemental iron for pregnant women?

    <p>60-80 mg</p> Signup and view all the answers

    Which route of administration is used for parenteral iron therapy?

    <p>Intramuscular injection</p> Signup and view all the answers

    In which scenario is parenteral iron therapy indicated?

    <p>Gastrointestinal disorders causing absorption issues</p> Signup and view all the answers

    When is iron supplementation generally started during pregnancy?

    <p>After 14 weeks gestation</p> Signup and view all the answers

    What is a common side effect of oral iron therapy?

    <p>Dark green or black stools</p> Signup and view all the answers

    What does a bone marrow biopsy reveal in the mentioned condition?

    <p>Nucleated RBCs and absent hemosiderin granules</p> Signup and view all the answers

    What responses can be expected from the treatment of oral iron therapy?

    <p>Increase in hemoglobin level by 1 gm/dl/month</p> Signup and view all the answers

    What causes the formation of Hb S in sickle cell disease?

    <p>Replacement of glutamic acid by valine at position 6</p> Signup and view all the answers

    Which dietary component is crucial for enhancing the absorption of iron?

    <p>Vitamin C</p> Signup and view all the answers

    What is the primary cause of aplastic anemia?

    <p>Bone marrow suppression</p> Signup and view all the answers

    During pregnancy, how much elemental iron is generally required to meet the increased needs?

    <p>1000 mg total throughout pregnancy</p> Signup and view all the answers

    Which of the following can significantly decrease iron absorption?

    <p>High intake of phytates or phosphates</p> Signup and view all the answers

    What is the expected reticulocyte count in anemia due to nutritional deficiencies?

    <p>Normal reticulocyte count</p> Signup and view all the answers

    Which symptom is commonly associated with anemia?

    <p>Easy fatigability</p> Signup and view all the answers

    What is the characteristic finding in the complete blood count (CBC) of anemia?

    <p>Normal platelet count</p> Signup and view all the answers

    What is the primary indicator of anemia in pregnant women based on RBC count?

    <p>RBC count below 3.5 million/mm3</p> Signup and view all the answers

    What causes the hemodilution observed in pregnant women leading to anemia?

    <p>Increased maternal plasma volume</p> Signup and view all the answers

    Which type of anemia is most commonly associated with pregnancy?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    What are the components of a hemoglobin molecule?

    <p>Heme and globin</p> Signup and view all the answers

    Which of the following describes the composition of adult hemoglobin (Hb A)?

    <p>2 α and 2 β chains</p> Signup and view all the answers

    What is a common cause of hemorrhagic anemia during pregnancy?

    <p>Acute or chronic blood loss</p> Signup and view all the answers

    Which type of anemia is characterized by unaltered indices?

    <p>Thalassemia</p> Signup and view all the answers

    What is the most common fetal complication related to maternal anemia?

    <p>Intrauterine growth restriction (IUGR)</p> Signup and view all the answers

    What role does folinic acid play in the body?

    <p>Folinic acid is necessary for DNA synthesis, cell growth, and cell division.</p> Signup and view all the answers

    What is the significance of urinary FIGLU levels in diagnosing folate deficiency?

    <p>Elevated urinary FIGLU levels indicate folate deficiency and help differentiate it from vitamin B12 deficiency.</p> Signup and view all the answers

    What are the recommended treatments for severe anemia near delivery?

    <p>The treatments include exchange transfusion with packed RBCs followed by parenteral vitamin therapy.</p> Signup and view all the answers

    Why are folate requirements increased during normal pregnancy?

    <p>Folate requirements increase due to the increased demand for DNA synthesis and cell division during fetal development.</p> Signup and view all the answers

    What distinguishes megaloblastic anemia from other forms of anemia in terms of clinical presentation?

    <p>Megaloblastic anemia typically presents similarly to iron deficiency anemia but shows a normal reticulocyte count.</p> Signup and view all the answers

    What changes in serum iron and ferritin levels are typically observed in the context of pregnancy-related anemia?

    <p>Both serum iron and serum ferritin levels are decreased.</p> Signup and view all the answers

    Which nutritional components are recommended to enhance iron absorption during pregnancy?

    <p>Vitamin C and folic acid are recommended to enhance iron absorption.</p> Signup and view all the answers

    What is the expected increase in hemoglobin (Hb) level from oral iron therapy per month?

    <p>The expected increase in Hb level is 1 gm/dl per month.</p> Signup and view all the answers

    What type of iron therapy is indicated in cases of severe anemia late in pregnancy?

    <p>Parenteral iron therapy is indicated for severe anemia late in pregnancy.</p> Signup and view all the answers

    What is the typical dose of elemental iron provided in oral iron therapy for pregnant women?

    <p>The typical dose is 60-80 mg of elemental iron daily.</p> Signup and view all the answers

    What are the expected responses to a blood transfusion in cases of severe anemia?

    <p>Each unit of blood is expected to increase hemoglobin levels by 0.5 gm/dl.</p> Signup and view all the answers

    What specific findings would one expect to see on a bone marrow biopsy in cases of anemia?

    <p>A bone marrow biopsy would show nucleated RBCs and absent hemosiderin granules.</p> Signup and view all the answers

    What are some common side effects associated with oral iron therapy?

    <p>Common side effects include gastric upsets, constipation, and dark green or black stools.</p> Signup and view all the answers

    What are the primary causes for iron deficiency anemia during pregnancy?

    <p>Iron deficiency anemia in pregnancy can be caused by decreased intake, decreased absorption, increased requirement due to fetal needs, and increased loss from chronic hemorrhage.</p> Signup and view all the answers

    How does the absorption of heme iron differ from non-heme iron?

    <p>Heme iron, found in red meat and liver, is rapidly absorbed compared to non-heme iron from plant sources like spinach and apples.</p> Signup and view all the answers

    What laboratory findings are associated with sickle cell disease?

    <p>In sickle cell disease, there is a decreased hemoglobin level, presence of anisocytosis and poikilocytosis in red blood cells, while leukocytes and platelets typically remain normal.</p> Signup and view all the answers

    What are some extrinsic causes of hemolytic anemia?

    <p>Extrinsic causes of hemolytic anemia include preeclampsia, prosthetic heart valves, and infections such as malaria.</p> Signup and view all the answers

    What is the impact of vitamin C on iron absorption?

    <p>Vitamin C enhances the absorption of iron by keeping it in the ferrous state, which is more easily absorbed in the intestines.</p> Signup and view all the answers

    How does sickle cell disease result in structural defects in red blood cells?

    <p>Sickle cell disease leads to the formation of Hb S due to the substitution of valine for glutamic acid, causing red blood cells to become rigid and sickle-shaped.</p> Signup and view all the answers

    What are the general symptoms of anemia?

    <p>Common symptoms of anemia include easy fatigability, pallor, shortness of breath, and heart palpitations.</p> Signup and view all the answers

    What role does dietary phytate play in iron absorption?

    <p>Phytate, found in various plant foods, significantly decreases iron absorption by binding to iron and inhibiting its uptake.</p> Signup and view all the answers

    What factors contribute to the hemodilution observed in pregnant women?

    <p>Increased maternal plasma volume and fetal utilization of nutrients lead to hemodilution.</p> Signup and view all the answers

    How is the composition of fetal hemoglobin (Hb F) different from adult hemoglobin (Hb A)?

    <p>Fetal hemoglobin (Hb F) consists of 2 α and 2 γ chains, while adult hemoglobin (Hb A) comprises 2 α and 2 β chains.</p> Signup and view all the answers

    What is the primary cause of iron deficiency anemia during pregnancy?

    <p>Iron deficiency anemia is primarily caused by inadequate iron intake to meet the increased demands of pregnancy.</p> Signup and view all the answers

    What are the typical laboratory indices associated with iron deficiency anemia?

    <p>Iron deficiency anemia typically shows low MCV, MCH, and MCHC indices.</p> Signup and view all the answers

    What complications can arise for the fetus due to maternal anemia?

    <p>Maternal anemia can lead to intrauterine growth restriction (IUGR) or intrauterine fetal demise (IUFD).</p> Signup and view all the answers

    Which type of anemia is associated with chronic or acute blood loss during pregnancy?

    <p>Hemorrhagic anemia is commonly associated with chronic or acute blood loss in pregnancy.</p> Signup and view all the answers

    What role do thalassemias play in the context of anemia during pregnancy?

    <p>Thalassemias are characterized by abnormal hemoglobin production, which can lead to anemia due to ineffective erythropoiesis.</p> Signup and view all the answers

    How can chronic infections contribute to anemia in pregnant women?

    <p>Chronic infections can lead to anemia through impaired erythropoiesis and increased destruction of red blood cells.</p> Signup and view all the answers

    Explain the role of folinic acid in the body and its importance during pregnancy.

    <p>Folinic acid is necessary for DNA synthesis, cell growth, and cell division, which are crucial during pregnancy for fetal development.</p> Signup and view all the answers

    Describe the main differences in laboratory findings between folate deficiency anemia and vitamin B12 deficiency.

    <p>In folate deficiency anemia, there are hypersegmented polymorphs and low plasma folate levels, while vitamin B12 deficiency typically shows a normal reticulocyte count and low plasma vitamin B12 levels.</p> Signup and view all the answers

    What clinical treatments are recommended for severe anemia in pregnant women near delivery?

    <p>Severe anemia near delivery is treated with exchange transfusion of packed RBCs followed by parenteral folic acid or cyanocobalamin therapy.</p> Signup and view all the answers

    Identify the common fetal complications associated with maternal anemia during pregnancy.

    <p>Common complications include intrauterine growth restriction (IUGR), neural tube defects (NTDs), and cleft lip and cleft palate.</p> Signup and view all the answers

    How does the body respond to the supplementation of folic acid and what is the expected laboratory indicator of efficacy?

    <p>The body responds to folic acid supplementation with clinical improvement and an increase in reticulocyte count.</p> Signup and view all the answers

    What is the expected increase in hemoglobin (Hb) per week from parenteral iron therapy?

    <p>0.8 gm/dl/week</p> Signup and view all the answers

    What is the recommended dosage of elemental iron for oral iron therapy during pregnancy?

    <p>Triple the prophylactic dose, typically around 60-80 mg elemental iron daily.</p> Signup and view all the answers

    What is a key indication for a blood transfusion in an anemic patient during pregnancy?

    <p>Severe anemia in gestational age greater than 35 weeks.</p> Signup and view all the answers

    What is the role of vitamin C in relation to iron supplementation?

    <p>It increases iron absorption.</p> Signup and view all the answers

    Name two potential side effects of parenteral iron therapy.

    <p>Pain and staining at the injection site, anaphylaxis.</p> Signup and view all the answers

    What laboratory finding is indicative of effective oral iron therapy response?

    <p>An increase in hemoglobin by 1 gm/dl/month.</p> Signup and view all the answers

    What should be assessed prior to administering intravenous iron?

    <p>Sensitivity testing.</p> Signup and view all the answers

    What is the necessary condition to consider oral iron therapy for pregnant women?

    <p>Mild anemia with enough time for correction (16-30 weeks GA).</p> Signup and view all the answers

    What are the structural abnormalities observed in red blood cells due to sickle cell disease?

    <p>The structural abnormalities include spherocytosis and elliptocytosis in red blood cells.</p> Signup and view all the answers

    What is the primary dietary source of heme iron, and how does its absorption compare to non-heme iron?

    <p>The primary dietary source of heme iron is red meat and liver, which is absorbed more rapidly than non-heme iron from plant sources.</p> Signup and view all the answers

    List two causes that lead to decreased iron absorption during pregnancy.

    <p>Vitamin C deficiency and excessive intake of phytates or phosphates lead to decreased iron absorption.</p> Signup and view all the answers

    What normal physiological changes lead to anemia in pregnant women?

    <p>Hemodilution due to increased blood volume and higher iron requirements for fetal growth lead to anemia in pregnant women.</p> Signup and view all the answers

    Which enzyme deficiencies are associated with specific types of red blood cell enzymatic defects?

    <p>G6PD deficiency and pyruvate kinase deficiency are the enzymatic defects associated with red blood cells.</p> Signup and view all the answers

    What are the four major components contributing to the additional iron requirements during pregnancy?

    <p>The additional iron requirements during pregnancy are for external loss, expansion of maternal cells, fetal needs, and the placenta and cord.</p> Signup and view all the answers

    Identify one common gastrointestinal symptom associated with anemia.

    <p>Common gastrointestinal symptoms include nausea and anorexia.</p> Signup and view all the answers

    Explain the significance of the ferritin-apoferritin system in iron absorption.

    <p>The ferritin-apoferritin system regulates iron storage and release, crucial for maintaining adequate iron levels in the body.</p> Signup and view all the answers

    Explain how increased maternal plasma volume leads to anemia during pregnancy.

    <p>Increased maternal plasma volume leads to hemodilution, where the concentration of red blood cells decreases in relation to plasma, resulting in anemia of pregnancy.</p> Signup and view all the answers

    Describe the composition of fetal hemoglobin (Hb F) compared to adult hemoglobin (Hb A).

    <p>Fetal hemoglobin (Hb F) is composed of 2 alpha and 2 gamma chains, while adult hemoglobin (Hb A) consists of 2 alpha and 2 beta chains.</p> Signup and view all the answers

    What is the primary biochemical difference between iron deficiency anemia and anemia of chronic disease?

    <p>Iron deficiency anemia typically shows low ferritin levels and low serum iron, while anemia of chronic disease usually presents with normal or elevated ferritin levels despite low serum iron.</p> Signup and view all the answers

    Identify factors that contribute to vitamin B12 deficiency anemia in pregnant women.

    <p>Factors include inadequate dietary intake of animal products, malabsorption issues, and increased metabolic demands during pregnancy.</p> Signup and view all the answers

    How do thalassemias affect hemoglobin synthesis?

    <p>Thalassemias result from genetic mutations affecting the production of alpha or beta globin chains, leading to an imbalanced hemoglobin composition.</p> Signup and view all the answers

    Discuss the consequences of fetal utilization of maternal hemoglobin components.

    <p>The fetal utilization of substrates for hemoglobin synthesis can lead to maternal anemia, as the fetus demands iron and other components necessary for its own development.</p> Signup and view all the answers

    What laboratory indices would typically be altered in hemorrhagic anemia during pregnancy?

    <p>In hemorrhagic anemia, hematocrit (Hct) and hemoglobin (Hb) levels typically decrease, while reticulocyte count may increase as the body responds to the blood loss.</p> Signup and view all the answers

    Explain the significance of mean corpuscular hemoglobin concentration (MCHC) in diagnosing anemia.

    <p>MCHC indicates the average concentration of hemoglobin in a given volume of packed red blood cells; low MCHC often signifies hypochromic anemia, such as iron deficiency anemia.</p> Signup and view all the answers

    Study Notes

    Anemia in Pregnancy

    • Anemia during pregnancy is defined by RBC count <3.5 million/mm3 or Hb level <11 gm/dl, leading to reduced blood oxygen-carrying capacity.
    • Affects >50% of pregnant women; often aggravated by increased maternal plasma volume (hemodilution) and fetal nutrient utilization.
    • Maternal complications include preeclampsia, placental abruption, abortion, preterm labor, postpartum hemorrhage, and puerperal sepsis.
    • Fetal complications include intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD).
    • Hemoglobin (Hb) consists of heme (iron-containing porphyrin) and globin (protein with two pairs of polypeptide chains).
    • Adult Hb (Hb A) has 2 α and 2 β chains; fetal Hb (Hb F) has 2 α and 2 γ chains, showing higher oxygen affinity.

    Anemia Classifications and Indices

    • Color Index (CI): Hb level (% of normal) / RBCs count (% of normal) = 1 (normal)
    • Mean Corpuscular Volume (MCV): Hct value / RBCs count = 90 μ3 (normal)
    • Mean Corpuscular Hemoglobin (MCH): Hb level / RBCs count = 30 pg (normal)
    • Mean Corpuscular Hemoglobin Concentration (MCHC): Hb level / Hct value = 33 gm/dl (normal)

    Types of Anemia

    • Microcytic, Hypochromic Anemia (↓ Indices):

      • Iron deficiency anemia: Most common cause in pregnancy.
      • Vitamin B6 deficiency anemia.
      • Chronic infection: Third most common cause.
      • Chronic lead poisoning.
      • Certain thalassemias.

    • Macrocytic, Normochromic Anemia (↑ Indices):

      • Folic acid deficiency anemia.
      • Vitamin B12 deficiency anemia (pernicious anemia).

    • Normocytic, Normochromic Anemia (Unaltered Indices):

      • Hemorrhagic anemia: Second most common cause, due to acute or chronic blood loss.
      • Hemolytic anemia:
        • Immune (isoimmune, autoimmune)
        • Non-immune:
          • Intracorpuscular (thalassemias, sickle cell disease, RBC structural/enzymatic defects)
          • Extracorpuscular (preeclampsia, prosthetic heart valves, malaria)
      • Aplastic anemia: Due to bone marrow suppression.

    Iron Deficiency Anemia

    • Most common anemia during pregnancy; caused by insufficient iron intake/absorption or increased requirements/loss.
    • Daily iron intake: 14-15 mg; absorption: 10-15% (1-2 mg).
    • Iron absorption enhanced by ferrous state and vitamin C; reduced by phytates and phosphates. Heme iron (red meat, liver) is more readily absorbed.
    • Pregnancy increases iron needs ~1000 mg (compensate for loss, expand maternal cells, fetal needs, placenta/cord). Daily requirements increase to 30-60 mg.
    • Causes: decreased intake (poor diet, morning sickness), decreased absorption (vitamin C deficiency, increased phytates/phosphates, low gastric acidity, malabsorption, parasites), increased requirement (multifetal pregnancy, multiparity), and increased loss (chronic hemorrhage).
    • Symptoms: fatigue, fainting, blurred vision, pallor, glossy tongue, brittle nails, gastrointestinal upset, cardiovascular issues (palpitations, dyspnea, edema), and neurological symptoms (headache, numbness).
    • Diagnosis: Complete blood count (CBC) showing decreased Hb, RBCs with anisocytosis and poikilocytosis (varied size and shape), normal reticulocyte count, and decreased indices; blood chemistry showing decreased serum iron and ferritin; and bone marrow biopsy showing absent hemosiderin granules.
    • Prevention and Treatment: proper pregnancy spacing, pre-pregnancy nutritional counseling. Iron supplementation (60-80 mg elemental iron daily) starting after 16 weeks: ferrous fumarate, ferrous sulfate, or ferrous gluconate; additional vitamin C (1000mg) and folic acid (2mg). Oral iron (triple prophylactic dose, increases Hb by 1 gm/dl/month). Parenteral iron therapy for severe anemia, intolerance to oral iron, or malabsorption —dosage calculated (250mg elemental iron per gram of Hb deficit).

    Other Vitamin Deficiency Anemias

    • Folic acid and vitamin B12 deficiencies account for 3% of anemia cases in pregnancy.
    • Folic acid is essential for DNA synthesis and cell division.
    • Increased needs during pregnancy (200-300 μg/day).
    • Causes: iron deficiency anaemia, anticonvulsant/antipyretic therapy and chronic hemolysis.
    • Symptoms: similar to iron deficiency anemia, increase reticulocytes, hypersegmented polymorphs.
    • Diagnosis: CBC (decreased Hb, increased reticulocytes, hypersegmented polymorphs, increased indices), decreased plasma folate/B12, FIGLU (formimino-glutamic acid) in urine (elevated in folate, normal in B12 deficiency).
    • Treatment: Folic acid supplementation (400 μg/day); for severe anemia: exchange transfusion with packed RBCs, and parenteral folic acid/vitamin B12.
    • Vitamin B12 deficiency (pernicious anemia) is usually due to intrinsic factor deficiency. Symptoms similar to iron and folate deficiency, normal reticulocytes. Diagnosis via CBC, decreased plasma B12, normal FIGLU. Treatment similar to folate with parenteral cyanocobalamin.

    Blood Transfusion

    • Indicated for severe anemia when rapid correction is required (gestational age >35 weeks).
    • Each unit of blood increases Hb by 0.5 gm/dl.
    • Packed RBC's transfusion (to avoid circulatory overload) preferred over whole blood transfusion if available.

    Anemia in Pregnancy

    • Anemia during pregnancy is defined as a red blood cell (RBC) count below 3.5 million/mm³ or a hemoglobin (Hb) level below 11 gm/dl, resulting in reduced blood oxygen-carrying capacity.
    • Over 50% of pregnant women experience anemia.
    • Pre-existing anemia worsens during pregnancy due to increased maternal plasma volume (hemodilution) and fetal use of hemoglobin building blocks.
    • Maternal complications of anemia include preeclampsia, placental abruption, abortion, preterm labor, postpartum hemorrhage (PPH), and puerperal sepsis. Fetal complications include intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD).
    • Hemoglobin comprises heme (iron-containing porphyrin) and globin (protein with two pairs of polypeptide chains).
    • Adult hemoglobin (HbA) consists of two alpha and two beta chains, while fetal hemoglobin (HbF) has two alpha and two gamma chains, exhibiting higher oxygen affinity.
    • Hemoglobin indices include color index (CI), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC), with normal values provided in the text.

    Types of Anemia

    • Iron deficiency anemia: The most common type during pregnancy, characterized by decreased indices.
    • Vitamin B6 deficiency anemia.
    • Chronic infection: The third most prevalent cause.
    • Chronic lead poisoning.
    • Thalassemias: Certain types, showing increased indices.
    • Folic acid deficiency anemia.
    • Vitamin B12 deficiency anemia (pernicious anemia).
    • Hemorrhagic anemia: The second most common cause, stemming from acute or chronic blood loss.
    • Hemolytic anemia:
      • Immune hemolytic anemia (isoimmune as in blood transfusions, autoimmune as in hepatitis).
      • Non-immune hemolytic anemia:
        • Intracorpuscular causes (e.g., hemoglobinopathies like thalassemias and sickle cell disease; structural or enzymatic RBC defects).
        • Extracorpuscular causes (e.g., preeclampsia, prosthetic heart valves, malaria).
    • Aplastic anemia: Due to bone marrow suppression.

    Iron Deficiency Anemia

    • The most common type of anemia in pregnancy.
    • Daily dietary iron intake is 14-15 mg, with only 10-15% absorbed.
    • Iron absorption is enhanced in the ferrous state (with vitamin C) and reduced by phytates and phosphates.
    • Heme iron (from red meat and liver) is more readily absorbed than non-heme iron.
    • Pregnancy necessitates an additional 1000 mg of elemental iron (170 mg for loss, 450 mg for maternal expansion, 270 mg fetal needs, and 90 mg for placenta/cord). This increases daily needs to 30-60 mg and absorbed amount to 4mg.
    • Causes: decreased intake (poor diet, morning sickness), decreased absorption (vitamin C deficiency, increased phytates/phosphates, low gastric acidity, malabsorption, parasitic infections), increased requirements (multiple pregnancies, multiparity), increased loss (chronic hemorrhage).
    • Symptoms include fatigue, fainting, blurred vision, pallor, glossitis, brittle nails, gastrointestinal issues, cardiovascular issues (palpitation, dyspnea, edema), and neurological symptoms (headache, numbness).
    • Diagnosis involves complete blood count (CBC) showing decreased Hb, RBC anisocytosis/poikilocytosis, normal reticulocyte count, normal leukocytes/platelets, and decreased indices. Blood chemistry shows decreased serum iron/ferritin, increased iron-binding capacity, increased free erythrocyte protoporphyrin. Bone marrow biopsy shows nucleated RBCs and absent hemosiderin granules.

    Treatment of Iron Deficiency Anemia

    • Preventative measures: Proper pregnancy spacing, treating anemia before pregnancy, good nutrition.
    • Iron supplementation needed for all pregnant women after 16 weeks.
    • Supplementation with 60-80mg elemental iron (e.g., 200mg ferrous fumarate, 300mg ferrous sulfate, 550mg ferrous gluconate), 1000mg Vitamin C, and 2mg folic acid.
    • Oral iron therapy: Used for mild anemia. Increases Hb by 1 gm/dl per month. Side effects: Gastric upset, constipation, dark stools.
    • Parenteral iron therapy: Used for severe anemia (>30 weeks gestation), oral iron intolerance/ineffectiveness, or malabsorption. Dose calculation: 250mg elemental iron per gram of Hb below normal. Routes: IM or IV. Increases Hb by 0.8 gm/dl per week. Side effects: injection site pain/staining, hemosiderosis (overdose), anaphylaxis. Requires precautions for administration.
    • Blood transfusion: For severe anemia (>35 weeks GA) needing rapid correction. Increases Hb by 0.5 gm/dl per unit. Packed RBCs favored to avoid circulatory overload. Whole blood used if packed RBCs aren't available.
    • Treatment of associated conditions (e.g., hookworm infection).
    • Treatment assessed by clinical improvement and increased reticulocytes.

    Folic Acid and Vitamin B12 Deficiency Anemias

    • Account for 3% of anemia cases during pregnancy.
    • Folic acid is reduced to folinic acid (tetrahydrofolic acid) needed for DNA synthesis, cell growth, and division. Folate requirements increase during pregnancy (200-300 μg/day).
    • Deficiency may occur alongside iron deficiency anemia, anticonvulsant/antipyretic therapy, or chronic hemolysis.
    • Symptoms are similar to iron deficiency anemia; investigations include CBC (decreased Hb, increased reticulocytes, hypersegmented polymorphs, increased indices), decreased plasma folate levels, and increased urinary FIGLU (differentiates folate from B12 deficiency).
    • Treatment: Folic acid supplementation (400 μg/day) for all pregnant women. Mild anemia: oral folic acid (5 mg/day). Severe anemia: exchange transfusion followed by parenteral folic acid (1 mg/day IM for 1 week). Increased incidence of megaloblastic anemia, IUGR, neural tube defects (NTDs), cleft lip/palate.
    • Vitamin B12 deficiency is usually due to intrinsic factor deficiency. Symptoms are similar to iron deficiency anemia. Investigations involve CBC (similar to folate deficiency except normal reticulocytes), decreased plasma B12, and normal urinary FIGLU.
    • Treatment: Mild anemia: parenteral cyanocobalamin (250 μg/month IM). Severe anemia: exchange transfusion followed by parenteral cyanocobalamin (100 μg/day IM for 1 week).

    Anemia in Pregnancy

    • Anemia during pregnancy is defined as a reduced red blood cell (RBC) count (<3.5 million/mm3) and/or decreased hemoglobin (Hb) level (<11 gm/dl), leading to insufficient oxygen-carrying capacity.
    • More than half of pregnant women experience anemia.
    • Pre-existing anemia worsens due to increased maternal plasma volume exceeding RBC volume (hemodilution) and fetal Hb substrate utilization.
    • Maternal complications include preeclampsia, placental abruption, abortion, preterm labor, postpartum hemorrhage, and puerperal sepsis.
    • Fetal complications include intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD).
    • Hemoglobin comprises heme (iron-containing porphyrin) and globin (protein with two pairs of polypeptide chains).
    • Adult Hb (Hb A) consists of two α and two β chains, while fetal Hb (Hb F) has two α and two γ chains, exhibiting higher oxygen affinity.

    Classifying Anemia Based on Indices

    • Color index (CI): Hb level (% of normal) / RBCs count (% of normal) = 1 (normal)
    • Mean corpuscular volume (MCV): Hct value / RBCs count = 90 µ3 (normal)
    • Mean corpuscular hemoglobin (MCH): Hb level / RBCs count = 30 pg (normal)
    • Mean corpuscular hemoglobin concentration (MCHC): Hb level / Hct value = 33 gm/dl (normal)
    • Decreased Indices:* Iron deficiency anemia, Vitamin B6 deficiency anemia.
    • Increased Indices:* Folic acid deficiency anemia, Vitamin B12 deficiency anemia.
    • Unaltered Indices:* Hemorrhagic anemia, Hemolytic anemia (immune and non-immune), Aplastic anemia, Thalassemia, Sickle cell disease.

    Iron Deficiency Anemia

    • The most common cause of anemia during pregnancy.
    • Normal daily iron intake is 14-15 mg, with only 10-15% absorbed (1-2 mg elemental iron).
    • Ferrous iron absorption is enhanced by vitamin C and reduced by phytates and phosphates.
    • Heme iron (red meat, liver) absorbs faster than non-heme iron (vegetables).
    • Pregnancy increases iron needs by 1000 mg (170 mg for loss, 450 mg for maternal expansion, 270 mg for fetal needs, 90 mg for placenta/cord). This elevates daily requirements to 30-60 mg/day and absorbed amount to 4 mg (from 2 in non-pregnant adults).
    • Causes: Reduced intake (poor diet, hyperemesis gravidarum), reduced absorption (vitamin C deficiency, increased phytates/phosphates, reduced gastric acidity, malabsorption, parasitic infestations), increased requirements (multiple gestation, multiparity), increased loss (chronic blood loss).

    Iron Deficiency Anemia: Clinical Presentation and Diagnosis

    • Symptoms: Fatigue, fainting, blurred vision, pallor, glossitis, brittle nails, stomatitis, anorexia, nausea, vomiting, flatulence, constipation, palpitations, dyspnea, anginal pain, edema, water hammer pulse, heart sound changes, murmurs, heart failure (severe cases).

    • Diagnosis:

      • Complete blood count (CBC): Decreased Hb, anisocytosis, poikilocytosis, normal reticulocytes, normal leukocytes/platelets, decreased indices.
      • Blood chemistry: Decreased serum iron and ferritin, increased iron-binding capacity, increased free erythrocyte protoporphyrin.
      • Bone marrow biopsy: Nucleated RBCs, absent hemosiderin granules.

    Iron Deficiency Anemia: Prevention and Treatment

    • Prevention: Adequate spacing of pregnancies, treating pre-pregnancy anemia, good nutrition, balanced diet during pregnancy.

    • Treatment:

      • Iron supplementation: All pregnant women need it (started after 16 weeks). 60-80 mg elemental iron daily (e.g., 200 mg ferrous fumarate, 300 mg ferrous sulfate, 550 mg ferrous gluconate). Supplement with 1000 mg Vitamin C and 2 mg folic acid.
      • Oral iron therapy: Mild anemia, sufficient time for correction (16-30 weeks). Triple prophylactic dose; increases Hb by 1 gm/dl/month. Side effects include gastric upset, constipation, dark stools.
      • Parenteral iron therapy: Severe anemia near term (>30 weeks), oral iron intolerance/ineffectiveness, gastrointestinal disorders. Dosage calculated (250 mg elemental iron per gram Hb below normal). Administered IM or IV. Increases Hb by 0.8 gm/dl/week. Side effects: Injection site pain, staining, hemosiderosis (overdose), anaphylaxis.
      • Blood transfusion: Severe anemia (GA >35 weeks), rapid correction needed. Each unit increases Hb by 0.5 gm/dl. Packed RBCs preferred to avoid circulatory overload. Used if packed RBCs unavailable.
      • Treat associated conditions, monitor clinical improvement and reticulocyte count.

    Megaloblastic Anemia (Folic Acid and Vitamin B12 Deficiency)

    • Accounts for 3% of anemia in pregnancy.
    • Folic acid is reduced to tetrahydrofolic acid (folinic acid), crucial for DNA synthesis, cell growth, and division.
    • Pregnancy increases folate needs (200-300 µg/day).
    • Often accompanies iron deficiency anemia, plus anticonvulsant therapy, antipyretic therapy, chronic hemolysis.
    • Clinical presentation: Similar to iron deficiency anemia.
    • Diagnosis:
      • CBC: decreased Hb, increased reticulocytes, hypersegmented polymorphs, increased indices.
      • Blood chemistry: decreased plasma folate.
      • Urinary FIGLU: Increased (differentiates from Vitamin B12 deficiency).

    Megaloblastic Anemia Treatment

    • Prevention: Folic acid supplementation (400 µg/day) for all pregnant women.
    • Treatment: -Mild anemia: Oral folic acid (5 mg/day). -Severe anemia near delivery: Exchange transfusion (packed RBCs) followed by parenteral folic acid (1 mg/day IM for 1 week).

    Vitamin B12 Deficiency Anemia

    • Usually due to intrinsic factor deficiency.

    • Clinical picture: Similar to iron deficiency anemia.

    • Diagnosis:

      • CBC: Similar to folic acid deficiency, except for normal reticulocyte count.
      • Blood chemistry: Decreased plasma vitamin B12.
      • Urinary FIGLU: Normal.

    • Treatment:

      • Mild anemia: Parenteral cyanocobalamin (250 µg/month IM).
      • Severe anemia near delivery: Exchange transfusion (packed RBCs) and parenteral cyanocobalamin (100 µg/day IM for 1 week).

    • Increased risk of megaloblastic anemia, IUGR, neural tube defects (NTDs), cleft lip and palate.

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    Anemia in Pregnancy PDF

    Description

    This quiz covers the impact of anemia during pregnancy, including its definitions, causes, and classification indices. Learn about the maternal and fetal complications associated with anemia and the components of hemoglobin. Understand how anemia affects over 50% of pregnant women and the importance of managing this condition.

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