Megaloblastic anemia in Pregnancy

MEGALOBLASTIC ANEMIA

SURJEET ACHARYA

VMC

Objective

INTRODUCTION

EPIDEMIOLOGY

PATHOGENESIS

CAUSES

CLINICAL FEATURES

TREATMENT

Introduction

Anemia due to

- deficiency in Vitamin B12

- deficiency in Folic acid

- disturbance in Folic acid metabolism

This is characterised by presence of

- megaloblast

- hypersegmented nuetrophil

INCIDENCE

0.5%-3% pregnant female (esp. Multigravida)

VITAMIN B12 deficiency is RARE in PREGNANCY

Normal folate store lasts for 6 weeks

PATHOGENESIS

receptor

Into plasma

Deoxy thymidilatemonophosphate

polyglutamates

monoglutamate

INTO PLASMA

CAUSES

VITAMIN B12

• Vegeterian diet (not even milk and milk products)Inadequate

intake

• Gastritis

• Gastrectomy

• Ileal bypass surgery

• Crohn’s disease

• Tumor of ileum

• PPH

Malabsorption

FOLIC ACID

• Nausea, Vomiting, LOA

• Decreased dietary intakeInadequate intake

• Multiple pregnancy

• Growing fetusIncreased demand

• Infection

• AnticonvulsantFailure of utilization

• Liver disorder

• Vitamin C deficiencyDiminished storage

• Infection- hookworm, malaria,

• Hemorrhage- peptic ulcer, hemorrhoidsAbnormal demand

Symptoms

Signs

PALLOR

GLOSSITISHEPATOSPLENOMEGALY

MCV increased

MCH raised

MCHC normal

Lymphopenia, Thrombocytopenia

Red cell folate <3ng/ml (N=2.8-8ng/ml)

Serum B12 <90pg/ml (N=300ng/ml)

Daily requirement during pregnancy

Vit B12 – 3 µg

Folic acid – 200 µg

MANAGEMENT

Prophylactic therapy

Curative therapy

Prophylactic therapy

All women of reproductive age – 400 µg of FA daily

Conditions with increased demand

Multiple pregnancy

Under anti convulsant therapy

Hemoglobinopathies

Associated chronic infections or diseases

Infants with neural tube defects

4 mg of FA daily started 1 month prior to conception upto 12 weeks of pregnancy

Curative therapy

4 mg of FA orally daily continued for

atleast 4 weeks following delivery

1 mg of FA daily with iron and

nutritious diet – pregnancy induced

MA

In general, always given with iron supplementation

Response by 7 – 10 days, evidenced by

Sense of well being

Increased appetite

Increased reticulocytes, leucocytes &

thrombocyte count

Rise in Hb level

Supplementary i.m 100 µg of vit B12

daily or on alternate days – response

to FA alone not adequate

Tab. Ascorbic acid 100 mg TID –

enhances FA action by converting it

into folinic acid

Thank you!