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Anemias in Pregnancy By AHMED MALIBARY, M.D.
Objectives Risk of anemia Iron requirements in pregnancy Types Managment
Definition: Anemia in pregnancy is generally defined as a hemoticrit less than 30% or a HB less than 10 g/dl
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
Classification Nutritional anemia iron deficiency anemia Folate deficiency Vit. B12 deficiency Anemia due to chronic blood loss Anemia due to hemolysis Aplastic anemia
Causes of Folic acid deficiency anemia -Decrease intake -Nutritional deficiency -Alcoholism Malabsorption -Coeliac diseases -Crohns disease -Tropical sprue -Gastroctomy -Drugs
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
Causes of vitB12 deficiency Malabsorption Pernicious anemia
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
Clinical Manifestations Fatigue Anorexia Dyspnoea Lssitude Breathlessness HF Signs
Effect on Mother Preterm labor PIH Intercurrent infection Obstetric shock Abruptio placentae CHF Purerperal sepsis
Effect on the Fetus Preterm labor(Prematurity) IUGR Stillbirth Neonatal anemia Increased perinatal mortality
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
HBSS CLINICAL MANIFESTATION INCLUDE: Chronic anemia Crises Sickle cell HbC disease Milder form Near normal hb levels Crises during pregnancy HbAS Rarely causes problems
The Thalassemias The beta-thalassemia: inability to synthesized adult beta chains The alpha-thalassemia: Inability to produce alpha-chains common to hemoglobin A