anemia pregnancy
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ANAEMIA IN PREGNANCY
(IRON DEFICIENCY)
សាស្រ្តាសា� ចារ្យវេជ្ជបណ្ឌិ ត ឯក វេ��ងលីឯកវេ�សផ្នែ��កស�្ភព និង វេ គស្រ្តាស�ី, គត៌មានបិត�ិ វេ%កូសាស្រ្តាស្ដ ថតនិងឆ្លុះ
មាត់ស្ូបន
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មាតិកា
1) WOMEN HEALTH IN CAMBODIA2) ANAEMIA IN PREGNANCY3) RISK FACTOR ANEMIA 4) NORMAL IRON CYCLE5) SIGN AND SYMPTOM OF ANEMIA6) MANAGEMENT
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2008 Estimation developed by WHO, UNICEF, UNFPA and World Bank
National estimation and CDHS
690
900
640 600
470 437350
472
290206
1990 1995 2000 2005 2010
GRtamrNPaBmataBIqñaM1990-2014
CDHS, 2010
�ូលវេ0តុនៃន�រណៈភាពរបស់ទារកចំនួន3.1លាន នាក់ក�ុង193 ស្រ្តាបវេ�សក�ុងឆ្នា� ំ
2010
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%ស្រ្តា;នៃនជ�្ងឺកង្វះឈា�ស្រ្តាក0�ចំវេ@ះស្រ្តាស�ីក�្ពុជា
ប្រស្តីកម្ពុជាប្រ�មាណជា 45% ប្រ��ូបានរកវេKីញថាមាន ជម្ងឺ កង្វះឈាមប្រកហម។ ក�ងុវេនាះផ្នែRរ 38% នៃនប្រស្តីទាងំវេនាះមានជម្ងឺកង្វះឈាមប្រកហមកប្រមិ�ប្រសាល
ប្រសាល មធ្យម ធ្ងន់ធ្ងរ
38.4%
6.7%
0.2%
Adopted from: Table 3, CDHS2014
ANAEMIA IN PREGNANCY
It is the commonest medical disorder of pregnancy.
Physiological changes.Plasma volume increase by 50%.Red cell mass increase by 25%.Fall in Hb concentration and Ht
due to haemodilution.
Definition: Anemia Hb concentration should fall below 11g/dl (or Ht <32%) in pregnancy to diagnose anemia.
WHO grading of anemia Mild anemia 10 g/dl Moderate anemia 7- 10 g/dl Severe anemia < 7g/dl
ANEMIA IN PREGNANCY
Prevalence Anemia
Prevalence in pregnant women– 14 % - Developed Countries– 51% - Developing Countries– 65-75% - India– 80 % leading to maternal deaths
90% have iron deficiency anemia 5% folic acid deficiency
Common Anemia in pregnancy
1) Nutritional Deficiency - Iron deficiency - Folic acid deficiency - Vit. B12 deficiency
2) Hemoglobinopathies - Thalassemia - Sickle Cell Disease (susceptible hypoxia when O2 supply reduced)
- Rare types: Aplastic, Leukemia, Autoimmune hemolytic,
3) Red blood cell loss: Menorrhagia 20-30%
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RISK FACROR
Normal iron metabolism
The primary function is oxygen transport. Iron is absorbed by duodenum and jejunumAverage total body iron content 3500-4000 mg.Approximately 2/3 found in hemoglobin, Iron is also stored in RE cells (Bone marrow,
Spleen and liver) as hemosiderin and ferritin.Transport of electrons within cellsCo-factor of essential enzymatic : HemeImmunity: free radicals to destroy microbes
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Normal Iron Cycle
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Normal Iron Cycle
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IRON Requirements during Pregnancy
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តំរូការ ជាតិផ្នែCក
NIH Office of Dietary Supplementshttps://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ (accessed: Sept 2015)
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មានគភ៌ សារៈស្រ្តាបវេDជន៍ចំវេ@ះទារក
ជួយ�វេងWី�វេកាសិកាឈាម ជួយRល់មុខងារ និងការ8ភិ�ឌ្ឍន៍នៃន
ខួរក្បាល
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Symptoms of IRON DEFICIENCY
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Symptoms of IRON DEFICIENCY
Effects of Anemia in pregnancy
INVESTIGATIONS
Low Hemoglobin and Hematocrit RBC Indices: Low PCV, MCV, MCH, MCHC Low serum ferritin < 15 mcg/dl: most sensitive Low serum iron content (<30mcg/dl) Increased serum transferrin (>8 mg/l) Urine for hematuria Stool examination Electrophoresis Hb (Typing) Bone marrow examination.
MANAGEMENT (1)
Objectives: 1- To achieve a normal Hb by end of pregnancy 2- To replenish iron stores Two ways to correct anemia: 1- Iron supplementation: Oral and Parenteral 2- Blood transfusion Choice of method: depends on 3 main factors:
1- Severity of the anemia2- Gestational Age3- Presence of additional risk factor
MANAGEMENT (2)
Improving diet rich in iron & fruits & leafy vegetables
Treat worm infections, maintain general hygiene
Food fortification with iron & genetic modification of food
Iron & folic acid supplementation in young girls & during pregnancy
MANAGEMENT (3) WHO - 60 mg Elemental iron +
400 micro gram Folic acid/day * 6 months & 3 months postpartum
In anemia therapeutic doses are 120-200 mg /day
Iron supplementation not recommended in first trimester– Higher incidence of miscarriage– Birth defects– Bacterial infection (bacteria grow
after taking iron from supplementation)
MANAGEMENT (4)
Severe anemia: (Hb < 8gm/dl)Parenteral therapy in IM or IV iron
- IM : Iron sorbitol - IV : Iron sucrose
Blood transfusion: May be required to treat severe anemia near term or
when some other complication such as placenta praevia present.
Gross anemia• Packed red cells transfusion • Exchange transfusion
Side Effect of Fer Side effect of Fe Oral therapy: . G. I upset. . Constipation. . Diarrhea.Parenteral: - Skin discoloration - Local abscess - Allergic reaction - Fe over load.
SUMMARYANAEMIA IN PREGNANCY (Iron deficiency)
Most common form of anemiaSymptom of pathologic processPrimary manifestation is hematologicTreatment requires:
– Replacement therapy– Correction of underlying cause (if possible)
Iron excess more dangerous than iron deficiency (Hemochromatosis)
Disease slide for publicPlease consult your physicians for further information.
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