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ANAEMIA IN PREGNANCY

(IRON DEFICIENCY)

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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

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1990 1995 2000 2005 2010

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CDHS, 2010

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2010

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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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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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