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28-year-old housewife20weeks pregnant

Gravida 1 Para0

PRESENTED WITH

1. Earlyfatigue

2. shortnessofbreath fromeventheslightest

exertion

3. periodsoflight-headedness,though nottothe

pointoffainting

4. crampingin herlegs,adesireto crunch onice,

andtonguesores.

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No hxofbleeding pv, heamaturia,or hematemesis

thefirstdayofherlastmenstrual periodwas Dec

18th

By Nageles'srule, herestimateddateofdeliveryis

Sep 25th.

Planned pregnancy, confirmed byurinetest,

Unbooked

No complicationduring1sttrimester

Rhesus +veandrubellaimmune

Nosignificant pastmedicalorsurgical Hx

NosignfFHx

Herlastsmeartestwasin2005itwasnormal

She hasaregular 28 daycycle

No Hxofsmokingoralcoholintake

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Onexamination

VITALS:

TEMP: A/F

PULSE: 90bpm

BP:110/80

RR: 13 br.pm

Pale conjuctiva, palegumsandnail beds

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CBC REPORTRed Blood Cell Count 3.5 million/mm3

Hemoglobin (Hb) 7 g/dl

Hematocrit (Hct) 30%

Mean Corpuscular Volume

(MCV)

65%

Mean Corpuscular Hb

Concentration (MCHC)

25g/dl

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DIAGNOSIS ???

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DIAGNOSIS

MICROCYTIC ANEAMIA

May beirondeforthallesemiaminor !!

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WatwoulduthinkofifMCVwould be

increased ???

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FURTHER INVESTIGATIONS ???

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Anemia

Dilutionalorphysiologic

Iron Deficiency Anemia

Thalassemias

FolateorVit B12defanemia

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Physiologic AnemiaofPregnancy

ANEMIA IN PREGNANCY

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Physiologic AnemiaofPregnancy

Pregnancy-induced hypervolemia hasseveralimportantfunctions:

1. Tomeetthedemandsoftheenlarged

uteruswith itsgreatly hypertrophiedvascularsystem.

2. To protectthemother,andinturnthefetus,againstthedeleteriouseffectsof

impairedvenousreturninthesupineanderect positions.

3. Tosafeguardthemotheragainsttheadverseeffectsofbloodlossassociated

with parturition. Williams2006

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Anemia- INVESTIGATION

CDC:

ifHb is < 11 in 1st or3rd tri,or

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Anemia- INVESTIGATION

Hemoglobinopathy bulletinrecommends

IfMCV15, IT excludesiron-deficiency

obtain Hb electrophoresis

B-thalwill haveelevated Hb A2orF

Ifelectrophoresisnegative,send DNA thalscreenforalpha-thal.

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TREATMENT

Ifiron-deficient,treatwith ironuntil

Hb innormalrange (over11)

Useferroussulfate325mgonetablettaken

midmorningisusuallyeffective. Higherormorefrequentdosesincrease GI

adverseeffects,.

About20%ofpregnantwomendonotabsorb

enough supplementaloraliron;afewofthemrequire parenteraltherapy,

usuallyirondextran100mg IM everyotherday

foratotalof 1000mgover3wk.

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TREATMENT

Ifnotirondeficient,ruleoutthalassemias

Noneedtotreatifferritinok

Iflowgive 1gmferroussulphateOD

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TREATMENT

All pregnantwomenaregivenfolate0.7

2mgfolic acidoralonce/day.

Womenwho have hadafetuswith spina

bifidashouldtake4.0mgonce/day,starting before conception.

INC doseupto5gmifpttakinganti

convulsants.

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THANK YOU