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  1. Anemias in Pregnancy By AHMED MALIBARY, M.D.

  2. Objectives Risk of anemia Iron requirements in pregnancy Types Managment

  3. Definition: Anemia in pregnancy is generally defined as a hemoticrit less than 30% or a HB less than 10 g/dl

  4. 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

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

  6. Causes of Folic acid deficiency anemia -Decrease intake -Nutritional deficiency -Alcoholism Malabsorption -Coeliac diseases -Crohns disease -Tropical sprue -Gastroctomy -Drugs

  7. 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

  8. Causes of vitB12 deficiency Malabsorption Pernicious anemia

  9. 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

  10. Clinical Manifestations Fatigue Anorexia Dyspnoea Lssitude Breathlessness HF Signs

  11. Effect on Mother Preterm labor PIH Intercurrent infection Obstetric shock Abruptio placentae CHF Purerperal sepsis

  12. Effect on the Fetus Preterm labor(Prematurity) IUGR Stillbirth Neonatal anemia Increased perinatal mortality

  13. 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

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

  15. The Thalassemias The beta-thalassemia: inability to synthesized adult beta chains The alpha-thalassemia: Inability to produce alpha-chains common to hemoglobin A