1. ANAEMIA IN PREGNANCY AHMED ABDULWAHAB

2. It is the commonest medical disorder of pregnancy. It is the commonest medical disorder of pregnancy. Physiological changes. Physiological changes. Plasma volume increase by 50%. Plasma volume increase by 50%. Red cell mass increase by 25%. Red cell mass increase by 25%. Fall in Hb concentration and haematocrit due to haemodilution. Fall in Hb concentration and haematocrit due to haemodilution. MCV increase secondary to erythropoiesis. MCV increase secondary to erythropoiesis.

3. Cont, Cont, MCHC remain stable. MCHC remain stable. Serum iron and ferritin decrease because of utilization. Serum iron and ferritin decrease because of utilization. Total iron binding capacity increases TIBC Total iron binding capacity increases TIBC Iron requirement increases total of 1000mg in whole pregnancy. Iron requirement increases total of 1000mg in whole pregnancy. Moderate increase in iron absorption. Moderate increase in iron absorption. Folate requirement increases Folate requirement increases

4. DEFINTION.. DEFINTION.. WHO recommended that Hb concentration should fall below 11gm/dl in pregnancy to diagnose anemia. WHO recommended that Hb concentration should fall below 11gm/dl in pregnancy to diagnose anemia. Incidence 30-50% pregnant women are having anemia at pregnancy. Incidence 30-50% pregnant women are having anemia at pregnancy. 90% have iron deficiency anemia. 90% have iron deficiency anemia. 5% folate deficiency. 5% folate deficiency.

5. CLINICAL FEATURE. CLINICAL FEATURE. Often asymptomatic. Often asymptomatic. Diagnosed in routine screening. Diagnosed in routine screening. Other,tiredness, dizziness,fainting, pallor may be apparent Other,tiredness, dizziness,fainting, pallor may be apparent

6. SCREENING. SCREENING. Routine screened by Hb concentration at the beginning of pregnancy. Routine screened by Hb concentration at the beginning of pregnancy. It is cheep and simple.. It is cheep and simple.. It does not reveal the cause. It does not reveal the cause.

7. IRON DEFICENCY ANAEMIA. IRON DEFICENCY ANAEMIA. It is microcytic hypochromic. Reduced MCV. MCHC. It is microcytic hypochromic. Reduced MCV. MCHC. Etiology. Etiology. Increase demand in pregnancy due to expanding red cell mass, fetal requirement.If iron stores are depleted because of menstruation, recurrent pregnancy,poor intake, anemia develops rapidly Increase demand in pregnancy due to expanding red cell mass, fetal requirement.If iron stores are depleted because of menstruation, recurrent pregnancy,poor intake, anemia develops rapidly

8. CONSEQUENCES. CONSEQUENCES. Preterm labor. Preterm labor. Infection Infection Medical intervention during labor. Medical intervention during labor. Post partum blood loss. Post partum blood loss. ? IUGR. ? IUGR.

9. TREATMENT. TREATMENT. Oral iron is effective when there is time. Oral iron is effective when there is time. Hb increase 0.8 g/dl per week Hb increase 0.8 g/dl per week Ferrous salt is better absorbed than the ferric form. Ferrous salt is better absorbed than the ferric form. Side effect depends on the amount of the of the elemental iron. Side effect depends on the amount of the of the elemental iron. Choice depends on cost and patient tolerance. Choice depends on cost and patient tolerance.

10. Cont. Cont. Vitamin –C helps absorption. Vitamin –C helps absorption. Main side effect are gastro intestinal, gastric upset and constipation. Main side effect are gastro intestinal, gastric upset and constipation. Indication for parenteral thereby. Indication for parenteral thereby. Lack of compliance, severe GIT side effect, mal absorption Lack of compliance, severe GIT side effect, mal absorption Intera muscular iron sorbitol Intera muscular iron sorbitol

11. Cont. Cont. Deep im it is painful cause discoloration of the skin. Deep im it is painful cause discoloration of the skin. High level may be excreted before utilization. High level may be excreted before utilization. IV IRON. IV IRON. Iron saccharate cause more rapid rise in Hb and has fewer side effect. Compared Iron saccharate cause more rapid rise in Hb and has fewer side effect. Compared

12. Cont Cont To oral iron but more invasive, need admission to hospital, it is true alternative to blood transfusion. To oral iron but more invasive, need admission to hospital, it is true alternative to blood transfusion. Blood transfusion, Blood transfusion, Most rapid way to increase the Hb. Most rapid way to increase the Hb. Used when there is no time to correct anemia. Used when there is no time to correct anemia. Risks include allergy and transmission of infection Risks include allergy and transmission of infection

13. Cont. Cont. Prevention is possible with good balanced diet. Prevention is possible with good balanced diet. Identification and treatment of iron deficiency prior to pregnancy are optimal. Identification and treatment of iron deficiency prior to pregnancy are optimal. Routine iron supplementation in pregnancy improve in hematological indices. Routine iron supplementation in pregnancy improve in hematological indices.