Anemias in Pregnancy

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Anemias in Pregnancy

• By
• AHMED MALIBARY, M.D.

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Objectives

• Risk of anemia
• Iron requirements in pregnancy
• Types
• Managment

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• Definition
• Anemia in pregnancy is generally defined as a
  hemoticrit less than 30 or a HB less than 10
  g/dl

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Iron deficiency anemia

• Responsible for 95 of anemia during pregnancy
• Total iron consists mostly of
• Iron in HB(70 of total iron)
• Iron stored as Feritin and hemosiderin in
  reticuloendthelial cells in BM, spleen, and
  parnAchymal cells of the liver
• Myoglobin, plasma, and various enzymes

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Classification

• Nutritional anemia
• iron deficiency anemia
• Folate deficiency
• Vit. B12 deficiency
• Anemia due to chronic blood loss
• Anemia due to hemolysis
• Aplastic anemia

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Causes of Folic acid deficiency anemia

• -Decrease intake
• -Nutritional deficiency
• -Alcoholism
• Malabsorption
• -Coeliac diseases
• -Crohns disease
• -Tropical sprue
• -Gastroctomy
• -Drugs

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• requirement
• Physiological pregnancy, prematurity, and
  infancy
• Pathological Chronic hemolytic anemia,
  myeloproliferative disorders, disseminated
  malignancy, chr.inflammatory disease
• Impaired utilization drugs, folic acid
  antagonist, liver disease

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Causes of vitB12 deficiency

• Malabsorption
• Pernicious anemia

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Iron Requirements in Pregnancy

• In normal pregnancy , a woman needs approximately
  800 mg of iron
• Fetus 300 mg
• Placenta 50 mg
• Increased red cell mass 410 mg
• Basal losses 220 mg
• Maternal blood loss at delivery 1230 mg

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Clinical Manifestations

• Fatigue
• Anorexia
• Dyspnoea
• Lssitude
• Breathlessness
• HF
• Signs

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Effect on Mother

• Preterm labor
• PIH
• Intercurrent infection
• Obstetric shock
• Abruptio placentae
• CHF
• Purerperal sepsis

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Effect on the Fetus

• Preterm labor(Prematurity)
• IUGR
• Stillbirth
• Neonatal anemia
• Increased perinatal mortality

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Sickle-cell Syndrome

• The heterozygous state for sickle cell hb(sickle
  cell trait,HBAS)
• The homozygous sickle cell disease HBSS
• Sickle cell HBC disease
• Sickle cell thalassaemia

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• HBSS
• CLINICAL MANIFESTATION INCLUDE
• Chronic anemia
• Crises
• Sickle cell HbC disease
• Milder form
• Near normal hb levels
• Crises during pregnancy
• HbAS
• Rarely causes problems

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The Thalassemias

• The beta-thalassemia inability to synthesized
  adult beta chains
• The alpha-thalassemia Inability to produce
  alpha-chains common to hemoglobin A