Professional Documents
Culture Documents
HERI|ITARY:
Y Thalassemias
Y Sickle cell haemoglobinopathies
Y Other haemoglobinopathies
Y Hereditary hemolytic anaemias (RBC membrane defects,
spherocytosis)
HAEMATOLOGICAL
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IRON |EFICIENCY
ANAEMIA
Y It is the commonest type of anaemia in pregnancy.
Y Food iron is made up of two pool
²Haem Iron Pool
²Non-
Non- Haem Iron Pool
Y Haem Iron Pool includes all food containing iron as
haem molecules, such as animal flesh and viscera. Its
absorption is 15-
15-30%, but it can increase to 50% in
iron deficiency state. Its absorption is usually not
affected by inhibitors.
IRON |EFICIENCY
ANAEMIA (Contd.)
Y Non
Non--Haem Iron Pool includes cereals, vegetables, milk
and eggs. Its absorption can be increased by enhancers
and decreased by inhibitors.
Y Enhancers of absorption: Haem iron, proteins, meat,
ascorbic acid, ferrous iron, gastric acidity, alcohol, low
iron stores, increased erythropoietic activity.
Y Inhibitors of iron absorption: Phytates, calcium, tannins,
tea & coffee.
CAUSES OF INCREASE|
PREVALENCE OF I.|.A
Y |ietary habits: Consumption of low-
low-bio availability diet
Y Food Fadism
Y |efective iron absorption due to intestinal infections,
hook worm infestation, amoebiasis, giardiasis.
Y Increased iron loss: Frequent pregnancies, menorrhagia,
hook worm infestation, chronic malaria, excessive
sweating, piles.
Y Repeated and closely spaced pregnancies and prolonged
period of lactation.
CLINICAL FEATURES
Y SIGNS:
Y a)PALLOR b)GLOSSITIS c)ULCERATION IN MOUTH
c)SOFT SYSTOLIC MURMUR IN MITRAL AREA
d)CREPITATIONS AT BASE OF LUNG
SYMPTOMS:
LASITTUDEEAKNESSEXHAUSTIONANOREXIA
GIDDINESSDYSPNOEA
IRON REQUIREMENT IN
PREGNANCY
Total iron requirement is 1000 mg.
Y Fetus and placenta -- 300 mg
Y Ń in red cell mass ² 500 mg
Y Basal loss ² 200 mg
Average requirement is 4-
4-6mg/day.
Y 2.5 mg/day in early pregnancy
Y 5.5 mg/day from 20-
20-32 weeks
Y 6-8 mg/day from 32 weeks onwards
SEVERITY OF ANAEMIA
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EFFECTS OF ANAEMIA ON
PREGNANCY
Y Maternal effects:
ANTE NATAL INTRA NATAL POST NATAL
Poor weight gain |ysfunctional labour Puerperal Sepsis
Preterm labour Haemorrhage & shock Sub-
Sub-involution
Pre--eclampsia
Pre Cardiac failure Embolism
Abruptio placentae
Inter current infections
PROM
EFFECTS OF ANAEMIA ON
PREGNANCY (Contd.)
Y Fetal effects:
² Risk of pre-
pre-maturity
² IUGR, LBW, poor apgar score
² |epleted iron store in neonates and anaemia in
infancy period
² High prevalence of failure to thrive and poor
intellectual development.
² Cardiovascular morbidity and mortality in adult lives.
PREVENTION OF IRON
|EFICIENCY
Y Prophylaxis of non-
non-pregnant women ² 60 mg of elemental
iron daily for 3 months.
Y Iron supplementation during pregnancy.
² Routine iron supplementation is debatable in western
countries
² It has to be given in non-
non-industrialized countries
² W.H.O RECOMMEN|ATION: Universal oral iron
supplementation for pregnant women (60 mg of
elemental iron and 250 µg of folic acid) for 6 months
in pregnancy and additional of 3 months post-
post-partum
where the prevalence is more than 40%.
PREVENTION OF IRON
|EFICIENCY (Contd.)
² MINISTRY OF HEALTH, GOVT. OF IN|IA
RECOMMEN|ATION: 100 mg of elemental iron with
500 µg of folic acid in second half of pregnancy for atleast
100 days. 2 injections of iron dextran (250 mg each) given
IMI at 4 weeks interval with TT injection.
Y Treatment of hook worm infestation
² Single albendazole (400 mg) or mebendazole (100 mg x B| x
3 days)
² Change in defecation habits and avoidance of walking bare
footed.
PREVENTION OF IRON
|EFICIENCY (Contd.)
Y Improvement of dietary habits and improving bio
availability of food iron
Y Iron fortification of food.
INVESTIGATIONS
Y Haemoglobin estimation
Y Peripheral blood smear ² microcytosis, hypochromia
anisocytosis, poykilocytosis and target cells
Y RBC indices ² ŅMCV, ŅMCH, ŅMCHC, MCV is the
most sensitive indicator
Y Ņ Serum ferritin ² first abnormal laboratory test
Y Ņ Transferrin saturation ² second to be affected
Y Ń FEP ² third test to become abnormal
Y Ń Serum transferrin receptor ² best indicator
INVESTIGATIONS (Contd.)
Y Bone marrow examination ² no response to treatment after
4 weeks of therapy
² Aplastic anaemia
² |iagnosis of kala-
kala-azar
² Urine examination
² Stool examination ² for three consecutive days
² Other tests ² RFT, LFT, TSP A:G, chest x-x-ray,
sputum examination, etc.
² For response ² haemoglobin and PBS, reticulocyte
count
MANAGEMENT OF IRON
|EFICIENCY ANAEMIA
AIM
Y To correct iron deficiency
Y To restore iron reserve
Y To correct associated complicating factor
CHOICE OF THERAPY
Y |epends on severity of anaemia
Y |uration of pregnancy
Y Associated complicating factor
MANAGEMENT (Contd.)
GENERAL TREATMENT
Y |ietary advice
Y Treatment of associated complicating factor
IRON THERAPY
Y Oral
Y Parenteral
ORAL IRON THERAPY
Y CAUSES:
Y INADEQUATE INTAKE
Y INCREASED DEMAND DUE TO:a)d maternal tissue
b)product of conception
Y DIMINISHED ABSORPTION
Y ABNORMAL DEMAND:a)twins b)infection
c)haemorrhagic states
Y FAILURE OF UTILISATION