Discuss anaemia in pregnancy

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ANAEMIA IN PREGNANCY
ABDUL HAMID
CAESAR MAKARA
FIDELIS HEBULEY
KENNETH KIBET

DEFINITIONS
 Anemia in pregnancy is often defined as a hemoglobin
measurement below 10 g/dL or hematocrit below 30%.
 Anemia in non-pregnant women is defined as hemoglobin
concentration less than 12 g/dL
 Centers for Disease Control defined anemia as less than 11
g/dL in the first and third trimesters, and less than 10.5 g/dL
in the second trimester.
 Any condition in which the number of red blood cells per
mm3, the amount of hemoglobin in 100 ml of blood, and/or
the volume of packed red blood cells per 100 ml of blood
are less than normal

 Anemia is a significant maternal problem during
pregnancy.
 A hemoglobin of less than 11 g/dL or a hematocrit of
less than 33% should be investigated and treated to
avoid blood transfusion and its related complications
 A pregnant woman will lose blood during delivery and
the puerperium, and an anemic woman is therefore at
increased jeopardy.

PHYSIOLOGY OF PREGNANCY
 With normal pregnancy, blood volume increases, which results in
a concomitant hemodilution.
 During pregnancy, the blood volume increases by about 50% and
the red blood cell mass by about 25%
 This physiologic hydremia of pregnancy will lower the hematocrit
but does not truly represent anemia.
 Although red blood cell mass increases during pregnancy, plasma
volume increases more, resulting in a relative anemia.
 This results in a physiologically lowered hemoglobin (Hb) level,
hematocrit (Hct) value, and red blood cell (RBC) count, but it has
no effect on the mean corpuscular volume (MCV).

 Pregnancy-induced hypervolemia has several
important functions:
 To meet the demands of the enlarged uterus with its
greatly hypertrophied vascular system.
 To protect the mother, and in turn the fetus, against the
deleterious effects of impaired venous return in the
supine and erect positions.
 To safeguard the mother against the adverse effects of
blood loss associated with parturition.

ETIOLOGY
Iron Deficiency Anemia
Acute Blood loss
Acquired

Anaemia of
Inflammation/Malignancy

Acquired hemolytic anemia
Aplastic/hypoplastic anemia

Anaemia
Hereditary

Thalassemias
Sickle-cell
hemoglobinopathies
Hereditary hemolytic
anemias
Other
hemoglobinopathies

IRON DEFICIENCY ANAEMIA
 The two most common causes of anemia during
pregnancy and the puerperium are iron deficiency
and acute blood loss
 Iron deficiency is responsible for about 95% of the
anemias during pregnancy, reflecting the increased
demands for iron

ETIOLOGY OF IDA
 A woman who is pregnant often has insufficient iron stores
to meet the demands of pregnancy.
 Poor nutritional status frequently is associated with irondeficiency anemia
 Malabsorption of iron.
 Many women enter pregnancy with low iron stores
resulting from heavy menstrual periods, previous
pregnancies, breast feeding, or poor nutrition.
 Physiological increase in iron requirements.
 True anemia is common, mainly because of the demands of
the developing fetus on iron and folic acid, particularly
during the later months of pregnancy.
 It is difficult to meet the increased requirement for iron
through diet, and anemia often develops unless iron
supplements are given.

PATHOGENESIS/CLINICAL FEATURES

 Red cells may not become hypo-chromic and
microcytic until the hematocrit has fallen significantly.
(fall in MCV and MCH)
 When this occurs, a serum iron lev...


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