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Case Report

Anemia in pregnancy
PUPUT PUJIAMA
2013730085
Introduction
In pregnancy the need for higher oxygen leads to
increased production of erythropoietin. As a result,
plasma volume increases and red blood cells
(erythrocytes) increase. However, an increase in plasma
volume occurs in larger proportions when compared with
an increase in erythrocytes resulting in a decrease in
hemoglobin (Hb) concentration due to hemodilution.
Identity

Name : Mrs. R
Name : Tn.A
Age : 19 years old
Age : 25 years old
Occupation : Housewife
Occupation : driver
Address : jl. Baros RH
Address : jl. Baros RH
didi sukardi
didi sukardi
Education : Senior high school
Education : Senior high school
Marital Status : Married
Marital Status : Married
Religion : Moslem
Religion : Moslem
Date of Admission: June, 15th

2017





Chief Complaint
The patient complained of dizziness and weakness
History of Present Illness
Patients come on 15 June 2017 with dizziness and
weakness since 1 week ago, and often feel the same
before. During pregnancy the patient complained of no
appetite. The patient claimed to be pregnant 9 months a
second pregnancy And the patient had a miscarriage a
year ago in the first pregnancy. no heartburn or There is
no sign of water output, fetal movement is still felt.
History of Past Illness

History of hypertension : Denied


History of diabetes mellitus : Denied
History of allergy : Denied
History of epilepsy : Denied
History of urinary tract/kidney disease : Denied
History of trauma : Denied
History of surgery : appendectomy
Family History
History of hypertension : denied
History of kidney disease : denied
History of diabetes mellitus : denied
History of auto immune disease : denied
History of cancer : denied
History of Anemia : existed
Menstruation History
Menarche : 13 years old
Menstrual Cycle : 30 days, regular with duration of 9 days,
changed 5 pads a day ( 100 cc)
Dysmenorrhea : (-)
First day last menstruation : 1st september 2016
Contraception History
NO HISTORY
Marital Status
Married once, and has been going on for 2 years
Obstetric History
Multigravida
Physical Examination
General condition : Moderate
Level of consciousness : Composmentis
Vital Sign
Blood Pressure : 120/70 mmHg
Heart Rate : 90 beats per minute
Respiratory rate : 20 times per minute
Temperature : 36,5 C
Height : 160 cms
Weight : 60 kgs
Weight before pregnancy : 50 kgs
IMT : 23,4 kg/m2
General Examination

Eyes : Anemi conjunctiva +/+; Icteric sclera -/-


Mouth : Wet oral mucosal membrane
Thorax
Heart : Regular 1st and 2nd heart sounds, gallop (-), murmur (-)
Lung : Vesicular breath sounds +/+, rhonchi -/-, wheezing -/-, crackles -/-
Mamae : Aerola hyperpigmentation, nipple retraction -/-, breast milk -/-
Abdomen
Inspectio : Convex, linea nigra (+), striae gravidarum (+)
Palpation : Tenderness (-).
Auscultation : Bowel sounds (+), 9x/m
Ekstremitas : , CRT > 2 seconds
Obstetric Examination
Inspection : convex
Palpation :
Leopold Manuver
Leopold 1 : soft and not fully rounded part was palpated
Leopold 2 : wide and flat part is at the maternal left side
Leopold 3 : hard and round part was palpated
Leopold 4 : convergent
Fundal height : 29 cm
EFW : 2480 gram
Uterine Contraction : -
Percussion : (-)
Auscultation : 143x/minute, reguler
Laboratory Results
Type Result Unit Normal Value

HEMATOLOGY

Hemoglobin 4.7 g/dL 1214

Leukocyte 6,200 /L 4,00010,000

Hematocrit 18 % 3747

Eritrocyte 3.2 /L 3.85.2

Erytrocytes Index

MCV 56 fL 80100

MCH 15 pg 2634

MCHC 26 g/dL 3236

Erythrocytes leukocytes Platelets

Morphology of peripheral blood Hypochromic microscopy, mild poicylocytosis, Sufficient leukocyte population, negative Sufficient platelet population, positive
normoblast cells neutrophils, negative blast cells platelet giant, negative blast cells

Imunoserologi

HIV Kualitatif Non reactive Non reactive


Working Diagnosis
G2P0A1 19 years old gravida 35-36 with anemia
Management
Observation chief complain
Blood transfusion until hb > 8 gr/dl
Biosanbe 2x1
Delivery Report
Date Subjective Objective Assessment Planning

June 16th 2016 dizziness and BP: 120/70 G1P0A0 19 years old - Observe the vital signs
10am weakness HR: 90 bpm gravida 35-36 weeks - Observe his and
RR: 20 times/min with anemia vaginal output
Temp: 35,00C - Biofanbe 2x1
Hb: 4,7 gr/dl - blood transfusion
High fundus Uteri = 29cm
His (-)
Fetal Heart Rate = 143bpm
June 17th dizziness and HR : 92 G1P0A0 19 years old - Biosanbe 2x1 p.o
weakness Td: 110/70 MmHg gravida 35-36 weeks - Dexametason 2x1 IM
RR : 22 times/mins with anemia - Ca glukonas IV
RR : 22 times/min -Check Hb after transfusion.
Temp : 36,3 C -further transfusion to hb> 8
Hight fundus uteri = 29 cm
His : (-)
Fetal heart rate : 145 bpm

June 18th Clients complain limp HR : 80 G1P0A0 19 years old -Observation of the main
and fetal movement is TD: 110/70 MmHg gravida 35-36 weeks complaint
still in the feel RR : 21 times/mins with anemia - Transfusion PCR to Hb> 8 g /
S : 36,6C dl
His : - - check Hb after transfusion.
Hight fundus uteri : 29cm
Fetal heart rate : 145 bpm
Case Analysis
Theory Case
History . These symptoms appear in each case of anemia Patient complaint about The patient confessed
after a decrease of hemoglobin to a certain level weak and lethargic. On physical examination in
(Hb <7 g / dl). Anemia syndrome consists of obtaining conjunctival anemis. Pasein claimed
weakness, lethargy, fatigue, ears ringing (tinnitus), to have long complained of similar things. On
blindfolded eyes, cold feet, shortness of breath and laboratory examination at get Hb 4 gr / dl
dyspepsia, on examination of pale patients, which
is easily seen in the conjunctiva, oral mucosa,
palms And tissues under the nail.
Risk factors - Excessive blood loss - The patient complained of a lot of
- Poor nutrition intake blood during menstruation
- Pregnancy - In the patient's anamnesis claimed
- Age not to eat meat and vegetables, in a
day the patient only ate once
- Current patient is 8 months pregnant
- Currently the patient is pregnant for
the second time at the age of 19
years
Physical examinations weakness, lethargy, fatigue, ears ringing (tinnitus), Patients come in 8 months pregnancy with complaints
blindfolded eyes, cold feet, shortness of breath and lethargy and lethargy, on the previous labolatorium
dyspepsia, on examination of pale patients, which is easily examination in get Hb 4 gr / dl. On physical
seen in the conjunctiva, oral mucosa, palms And tissues examination of conjunctival anemis
under the nail.

Laboratory studies - Hb 4,7 g/dl


- Morphology of peripheral blood Erythrocytes
Hypochromic microscopy, mild poicylocytosis, normoblast
cells
Pregnant women are said to be anemic when
Less hemoglobin or red blood levels From 11.00 gr%.
According to Word Health Organzsation (WHO) anemia
In pregnant women is the condition of the mother with levels of
Hb <11%.
Definition
defined anemia in iron-sup-plemented pregnant women
using a cutoff of the 5th percen tile11 g/dL in the first
and third trimesters, and 10.5 g/dL in the second
trimester. An ongoing study of 278 women is currently
evaluating the accuracy of an erythrogram and serum
ferritin levels for anemia diagnosis and prediction of
responsiveness to oral iron.
Risk Factors
Common causes of anemia are malnutrition, lack of iron,
loss Blood during past labor, and chronic diseases. In
pregnancy a decrease in hemoglobin levels are
encountered during Pregnancy caused by pregnancy due
to the requirement of food substance Increases and
changes occur in the blood.
Risk factor iron deficiency
Chronic blood loss : Female genital tract, menorrhagia,
metrorrhagia
Nutritional factors
Increase the iron needed : pregnancy
Iron reabsorption disorder
diagnosis
Anamnesis: anemic symptoms : (weakness, lethargy, dizzy
eyes)
physical examination : Pale patients, especially in the
conjunctiva and under the nails
laboratory examination : Obtained anemia hipokromik
mikrositer
management
Therapeutic casual therapy, which is the cause of the
cause of anemia. Ect, hookworm infection, hemorrhoid
treatment, menorraghia treatment. Casual therapy should
be given so that anemia does not recur.
Giving iron preparations to replace the iron deficiency in
the body
blood transfusion
References
Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman
BL, et al. Williams Obstetrics. 24th Edition. New York: Mc Graw Hill;
2014.
Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S. Buku Ajar
Ilmu Penyakit Dalam Jilid II edisi V. Jakarta: Interna Publishing: 20014
Saifudin, Abdul bari, wikjosastro, Gulardi H. Ilmu kebidanan. Jakarta:
PT bina pustaka. 2012
saifudin, Abdul bari, wikjosastro, Gulardi H. Buku Acuan Nasional
Pelayanan Kesehatan dan Neonatal. Jakarta : PT bina pustaka. 2012

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