Anaemia in Pregnancy

1. Anemia in
pregnancy
Update 1/11/2014
Juliana Mohd Basuni

2. definition
 defined as a decrease in the amount of red blood cells
(RBCs) or the amount of hemoglobin in the blood.
Anemia". http://www.merriam-webster.com/. Retrieved 7 July 2014.
Stedman's medical dictionary (28th ed. ed.). Philadelphia: Lippincott Williams & Wilkins. 2006. p. Anemia.
ISBN 9780781733908.
 It can also be defined as a lowered ability of the blood
to carry oxygen.
 Hematology : clinical principles and applications (3. ed. ed.). Philadelphia: Saunders. 2007. p. 220.
ISBN 9781416030065.

3.  Hemoglobin in red blood cells is an oxygen-carrying
protein that binds oxygen through its iron
component.
 Hemoglobin transports oxygen to most cells in the
body for the generation of energy.
 When hemoglobin levels are low less oxygen
reaches the cells to support the body’s activities

4. Normal physiological changes
in pregnancy
 Plasma volume (50%)
 Red cell mass ( 18 – 25 % depending on iron status)
 Physiologic dilution which is greatest at 32 weeks
gestation

5. WHO definition anemia in pregnancy
 Anaemia as defined by the World Health Organization as
haemoglobin levels of ≤ 11 g/dl.
 UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva, World
Health Organization, 2001
 HCT < 32%
gestation Hb
1st Trimester <11.0g/L
2nd Trimester < 10.5g/L
3rd Trimester < 11.0g/L

6. prevalence
 varies
 considerably because of differences in
socioeconomic conditions, lifestyles and health-seeking
behaviors across different cultures.
 Anaemia affects nearly half of all pregnant
women in the world:
 52% in developing countries
 23% in the developed world
 UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control.
Geneva, World Health Organization, 2001

7. Prevalence
WHO Global Database on Anemia 2008
Preschool children Pregnant women Non pregnant
women during
child bearing age
world 47% 42% 30%
malaysia 32% 38% 30%

8. classifcation
Severity of anemia Hb concentration in
pregnant women g/dL
Treatment
Mild 8 – 11 Oral haematinics or paranteral
iron therapy.
Moderate 6.0 – 8 Depending on period of
gestation < 36 weeks
gestation
Treat with oral haematinics
or paranteral iron therapy.
If symptomatic admit to
hospital.
> 36 weeks gestation
Paranteral iron in therapy.
Consider blood transfusion.
Severe < 6 Blood transfusion with 2
units packed cells.

9. problems
 Anaemia is one of the most prevalent nutritional
deficiency problems affecting pregnant women .
 Thangaleela T, Vijayalakshmi P. Prevalence of anaemia in pregnancy. Indian J Nutr Diet
1994;31:26-32
 The high prevalence of iron and other micronutrient
efficiencies among women during pregnancy in
developing countries is of concern and maternal anaemia
is still a cause of considerable maternal & perinatal
morbidity and mortality
 Cutner A, Bead R, Harding J. Failed response to treat anaemia in pregnancy: reasons and
evaluation. J Obstet Gynecol 1999;suppl.:S23-7
 one of the world's leading causes of disability
 one of the most serious global public health problems.

10. Anemia effects

11. Problems in postpartum period
 Uterine Atony
 PPH
 Mortality ( 20% )
 Depression
 Emotional instability
 Stress
 Lower cognitive performance tests

12. Iron deficiency anaemia:
 Requirements in pregnancy : 900 mg
 Daily iron requirement in pregnancy : 4mg
 2.5 mg/day in early pregnancy
 6 – 8 mg/day from 32 weeks onwards
 Absorption of iron is <10%, so an average of 40
mg dietary iron is required daily

14. ? Iron is important
 vital for all living organisms because
it is essential for multiple metabolic
processes, including oxygen
transport, DNA synthesis, and
electron transport.

15. Causes
Insufficient intake/ insufficient production ; nutrition , spacing , blood disease
Increase loss : bleeding/ hemolysis , infestation , renal disease
Increase demand : placenta , fetus , red blood cells expansion

16. Causes

17. Causes
 Poor nutrition
 Deficiencies of iron and other micronutrients
 Malaria
 Hookworm disease
 Schistosomiasis
 HIV infection
 Haemoglobinopathies are additional factors
 Van den Broek NR, White SA, Neilson JP. The relationship between asymptomatic
human immunodeficiency virus infection and the prevalence and severity of anemia
in pregnant Malawian women. Am J Trop Med Hyg 1998;59:1004-7

18. symptoms

19. signs

23. Ix
 FBC FBP Peripheral Blood Smear Reticulocyte count
 Serum Ferritin
 UFEME , Stool Ova cyst
 TIBC , Serum Iron
 Hb Electrophoresis if required
 Serum Folate /B12 if required

24. Management

25. Prevention of Anemia
Women should be encouraged to undergo
a pre-natal check up for early detection and
treatment of iron deficient anemia.
Proper spacing between two children
( contraceptions )
Having a well balanced diet rich in iron from
adolescence.
Regular screening for anemia.
Fortification of ready-to-eat food with iron
Avoid / Reduce smoking / alcohol
consumptions

26. Management for IDA
 Dietary advice : 10 – 15% absorption

27. management

28. Iron preparations

29. Treatment

30. Treatment
 Iron Deficiency Anemia:
 Treatment: 60 mg of elemental Fe (iron) orally every 6 to 12 hours
(e.g. 2 to 4 times per day)
 Prophylaxis: 60 mg of elemental Fe (iron) orally every day.
 Recommended Daily Intake
 Men: 8 mg elemental Fe (iron) orally once daily
 Women: 18 mg elemental Fe (iron) orally once daily
 Pregnant women: 27 mg elemental Fe (iron) orally once daily
 Lactating women: 9 mg elemental Fe (iron) orally once daily
 Parenteral & Oral Iron Products - GlobalRPh

33. Parenteral indications

34. Parenteral dosage
 Iron Dextran ( Imferon / Cosmofer )
 IM
 Dose :
 0.0442 x ( Desired Hb – Current Hb ) x Weight ( kg ) + 0.26 x Weight ( kg)
 Iron Sucrose ( Venofer )
 IV
 Dose :
 Prepregnancy Weight ( kg ) x Target Hb – Current Hb ) x 0.24 + 500mg
 Cosmofer can also be given in IV route

35. Management options : Blood
transfusion
 Symptomatic anaemia
 Hb < 6.0g% at 36weeks /close to delivery
 Hb < 10.0g% in Placenta Praevia for elective CS

36. management
 Treat infections
 Treat worm infestations :
Albendazole 400mg/ Mebendazole
500mg
 Treat Schistosomiasis : Praziquantel
 Treat Malaria :
Chloroquine/Hydroxychloroquine

37. Management options
Thalassaemia Syndromes

39. Conclusions
 Screen anemia in pregnancy at booking
 Rule out for thallasemia is necessary
 Supplementation with iron
 Dietary advice
 Noted the contraindications of iron therapy
 Continue supplemantation through
postpartum until cessation of lactation

41. Thank you