ANEMIA IN ANEMIA IN PREGNANCYPREGNANCY

PRESENTER : AKSHAY JADHAVPRESENTER : AKSHAY JADHAVROLL NO : 06ROLL NO : 06UNIV REG NO : 06M1607UNIV REG NO : 06M1607

SUBHEADINGS:SUBHEADINGS:

• DEFINITIONDEFINITION• CAUSESCAUSES• ETIOLOGYETIOLOGY

DEFINITIONDEFINITION

• Anemia• Anemia in pregnancy

ANEMIAANEMIA• from Ancient Greek “anaimia”, meaning "lack of blood“• DEFINITION:• Anemia is a state which is characterised by: - decrease in normal number of red blood cells (RBCs) - less than the normal quantity of hemoglobin in the blood - decreased oxygen-binding ability of each hemoglobin

molecule (due to deformity or lack in numerical development) - appropriate for that age and sex• Acc to WHO:• For Adult male <13g/dl• For Adult female <12g/dl (non-pregnant)

ANEMIA IN PREGNANEMIA IN PREGNANCYANCY• DEFINITION:• ACCORDING TO CDC ANEMIA IN PREGNANCY IS DEFINED AS: - Hb LESS THAN 11g/dl IN FIRST AND THIRD

TRIMESTER AND - Hb OF LESS THAN 10.5g/dl IN SECOND

TRIMESTER• ACCORDING TO WHO ANEMIA IN PREGNANCY IS DEFINED AS Hb LESS

THAN 11g/dl.

• The degree of anemia is graded according to the Hemoglobin (Hb) level as follows:

• Moderate Moderate 7.0 – 10.9 g/dl• Severe Severe 4.0 – 6.9 g/dl• Very severe Very severe < 4.0 g/dl

Mean hemoglobin concentrations ( ---- ) and 5th and 95th (o----o)percentiles for healthy pregnant women taking iron supplements. ( Data from Centre for Disease Control, 1989a)

CLASSIFICATION OF ANEMIACLASSIFICATION OF ANEMIA

• MORPHOLOGICAL CLASSIFICATIONMORPHOLOGICAL CLASSIFICATION

• ETIOLOGICAL CLASSIFICATIONETIOLOGICAL CLASSIFICATION

• CLINICAL CLASSIFICATIONCLINICAL CLASSIFICATION

MORPHOLOGICAL CLASSIFICATIONMORPHOLOGICAL CLASSIFICATION

MICROCYTIC HYPOCHROMICo IRON DEFICIENCY ANEMIAo SIDEROBLASTIC ANEMIAo THALASSEMIAo ANEMIA DUE TO CHRONIC DISORDERS

• NORMOCYTIC NORMOCHROMICo ACUTE BLOOD LOSSo HEMOLYTIC ANEMIAo BONE MARROW FAILUREo ANEMIA OF CHRONIC DISORDERS

• MACROCYTIC NORMOCHROMICo DEFICIENCY OF VIT B 12o DEFICIENCY OF FOLIC ACID

ETIOLOGICAL CLASSIFICATIONETIOLOGICAL CLASSIFICATION

PathologicalPathologicalPhysiologicalPhysiological

Pathological

NUTRITIONAL ANEMIA

• IRON DEFICIENCY• FOLIC ACID DEFICIENCY• VIT B 12 DEFICIENCY• PROTIEN DEFICIENCY

ANEMIA DUE TO BLOOD LOSS

ACUTE BLOOD LOSSACUTE BLOOD LOSS• ANTE PARTUM HEMORRHAGE• ABORTION• HYDATIDIFORM MOLE• ECTOPIC PREGNANCY

CHRONIC BLOOD LOSSCHRONIC BLOOD LOSS• BLEEDING PILES• HOOKWORM• MENORRHAGIA

ANEMIA DUE TO CHRONIC INFECTION

• MALARIA• TUBERCULOSIS• DYSENTRY• REPEATED UTI• PYELONEPHRITIS

ANEMIA DUE TO CHRONIC DISEASES

• RENAL DISEASE• LIVER DISEASE• NEOPLASM• INFLAMMATORY BOWEL DISEASE• SLE• GRANULOMATOUS DISEASES

ANEMIA DUE TO BONE MARROW INSUFFICIENCY

• HYPOPLASIA• APLASIA (APLASTIC ANEMIA)

HEREDITARY CAUSES OF ANEMIA

• THALASSEMIAS• SICKLE CELL HEMOGLOBINOPATHIES• OTHER HEMOGLOBINOPATHIES

HEMOLYTIC ANEMIAHEMOLYTIC ANEMIA

ACQUIRED

• AUTOIMMUNE HEMOLYTIC ANEMIA• DRUG INDUCED• PREGNANCY INDUCED• PAROXYSMAL NOCTURNAL HEMOGLOBINURIA

INHERITED

• HEREDITARY SPEROCYTOSIS• RED CELL ENZYME DEFICIENCIES

PREGNANCY ANEMIA

PhysiologicalPhysiological

• Concept• Occurs due to: - disproportionate increase in plasma volume,

RBC volume, and hemoglobin mass during pregnancy (hemodilution)

- there is marked demand of extra iron during pregnancy(esp. in second halfnegative iron balance)

• Similar to iron deficiency anemia

Criteria for Physiological Anemia:

The lower limit of physiological anemia during the second half of pregnancy should fulfill the following hematological values:

1.Hb- 10gm%2.RBC- 3.2 million/ cumm3.PCV- 30%4.Peripheral smear showingnormal morphology

of the RBC with central pallor

CLINICAL CLASSIFICATIONCLINICAL CLASSIFICATION• SYMPTOMATICSYMPTOMATIC

• ASYMPTOMATICASYMPTOMATIC

• MATERNAL MORTALITY 20 %• INCIDENCE OF ANEMIA

40 -80 % ---- IN DEVELOPING COUNTRIES 10 – 20 % ---- IN DEVELOPED COUNTRIES

Causes of increased prevalence (in Causes of increased prevalence (in tropics)tropics)

• Faulty dietetic habit• Faulty absorption mechanism• Iron loss: - more iron loss through sweat - Repeat pregnancies at short intervals - Excessive blood loss during menstruation - Hookworm infestation - Chronic malaria, bleeding piles & dysentry

Factors that lead to development of Factors that lead to development of anemia in pregnancyanemia in pregnancy

• Increased demands of iron• Diminished intake of iron• Disturbed metabolism• Pre-pregnant health status• Excess demand - multiple pregnancy - Women with rapidly recurring pregnancy - The demand of iron which accompanies the natural

growth before the age of 21

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