بسم الله الرحمن الرحـيـم ANEMIA DURING PREGNANCY Dr. Afaf I. Alnoury

ANEMIA DURING PREGNANCY PHYSIOLOGICAL CHANGES: DEFINITION OF ANAEMIA: Anemia in non-pregnant women is defined as hemoglobin concentration less than 12 gm% and less than 10 gm% during pregnancy or the puerperium The centre for disease control (1990) defined anemia as less than 11 gm% in the first and third trimesters, and less than 10.5 gm% in the second trimester. Dr. Afaf I. Alnoury

ANEMIA DURING PREGNANCY ETIOLOGY: The same as non-pregnant women CAUSES DURING PREGNANCY: Acquired: Iron deficiency anemia Acute blood loss Anemia of inflammation or malignancy Megaloblastic anemia Acquired hemolytic anemia Aplastic or hypoplastic anemia Hereditary: Thallasemia Sickle cell hemoglobinopathies Other hemoglobinopathies Hereditary, hemolytic anemia Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY Effect of anemia in pregnancy:  preterm labour  perinatal mortality  low birth weight Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY IRON DEFICIENCY ANAMIA The two most common causes of anemia during pregnancy and the puerperium are : iron deficiency and acute blood loss. The maternal need for iron induced by pregnancy is 800 mg: 300 mg for fetus and placenta 500 mg for maternal hemoglobin mass expansion + 200 mg are shed thru gut, urine & skin ---------------------- 1000 mg (exceeds the iron stores of most women) Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY IRON DEFICIENCY ANAMIA DIAGNOSIS: Hemoglobin, haematocrit, red cell indices, smear for peripheral blood, serum iron and serum ferritin TREATMENT: Ferrous sulfate, fumarate or gluconate 200 mg of elemental iron Blood transfusion, packed RBCs in acute emergency Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY MEGALOBLASTIC ANAMIA Rare Caused by impaired DNA synthesis Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY FOLIC ACID ANAMIA EFFECT ON MOTHER & FETUS: increase fetal malformation Pre-eclampsia Abruptio placenta Abortion Prematurity Low birth weight PREVENTION: 0 – 8 mg/day of folic acid TREATMENT: 1 mg/day of Folic acid + Nutritious diet and iron Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY VITAMIN B12 DEFICIENCY ANAMIA Very rare Addisonian pernicious anemia is characterized by the failure to absorb vitamin B12 because of lack of intrinsic factor Following partial or total gastric resection Crohn’s disease Ileal resection Bacterial overgrowth in the small bowel, 100μg cyanocobalamin IM monthly Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY ACQUIRED HEMOLYTIC ANAMIA Autoimmune hemolytic anemia Uncommon Direct and indirect antiglobulin tests +ve Spherocytosis, reticulocytosis in peripheral blood smear Prednisone 1 mg/kg/day Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY ACQUIRED HEMOLYTIC ANAMIA PRENANCY INDUCED HEMOLYTIC ANAMIA Rare Severe hemolysis develops early in pregnancy and resolves within months after delivery Corticosteroids effective Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY ACQUIRED HEMOLYTIC ANAMIA PAROXYSMAL NOCTURNAL HEMOGLOBINURIA Is a hemopoietic stem cell disorder characterized by Formation of defective platelets, granulocytes and erythrocytes CLINICAL MANIFESTATION: Insidious onset and chronic course Haemoglobinuria, not necessary nocturnal Haemoglobinuria by the transfusion, infection or surgery Anemia Thrombocytopenia Venous thrombosis Hepatic vein thrombosis  Budd Chiari Syndrome Renal abnormalities hypertension Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY TREATMENT: Heparin therapy Corticosteroids Transfusion Marrow transplant EFFECTS ON PREGNANCY: Maternal death Increase perinatal mortality DVT Hepatic venous thrombosis Cerebral venous thrombosis Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY ACQUIRED HEMOLYTIC ANAMIA DRUG INDUCED ANAMIA Mild Resolves upon withdrawing the drug Can be prevented Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY ACQUIRED HEMOLYTIC ANAMIA APLASTIC or HYPOLASTIC ANAMIA Rarely encountered during pregnancy With severe disease one year survival rate 20% Chance associated 1/3 improved following termination of pregnancy, and recur with a subsequent pregnancy Risk of hemorrhage and infection Mortality 50% Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY APLASTIC or HYPOLASTIC ANAMIA Management: Bone marrow transplantation Corticosteroids Large dose of androgenic steroids Tithymocyte Treat infection Vaginal delivery Dr. Afaf I. Alnoury

ANAEMIA DURING PREGNANCY HAEMOGLOBINOPATHIES Sickle cell Hemoglobin C. and C.B. Thallasemia Thallasemia Dr. Afaf I. Alnoury

Thank You Dr. Afaf I. Alnoury