ANEMIA IN PREGNANCY

Prof. DR. Jusuf S. Effendi., dr.,

SpOG(K)

Anemia in Pregnancy
Anemia is the most common hematologic
abnormality
Anemia a reduction in concentration of
erythrocytes or hemoglobin in blood
Most common causes :
Iron deficiency and blood loss

Classification
Aquired
Deficiency anemia
(eg,iron, vitamin B12,
folate)

Hemorrhagic anemia
Anemia of chronic
disease
Acquired hemolytic
anemia
Aplastic anemia

Inherited
Thalassemias
Sickle cell anemia
Hemoglobinopathies
Inherited hemolytic
anemias

Other Classification

Anemia in Pregnancy
Increased iron requirement
Physiologic
blood volume expands by
aproximately 50 %
changes in
(1000 mL)
Red blood cell mass
pregnancy
expands by aproximately
25 % (300 mL)
may
complicated
Greater expansion in
plasma Hgb and Hct
hematologic
levels
disorderTotal amount of iron in the body

intake, loss
and storage

determined by

Iron Deficiency Anemia

Abnormal values of
biochemical test result
increases of hemoglobin
concentrations of more then 1 g/dL
after iron treatment
Absent bone marrow iron stores as
determines by bone marrow smear

Primary screening Hgb

& Hct concentration

Laboratory test
result caractheristic :
Microcytic
hypochromic anemia with
evidence depleted iron
stores
Low plasma iron levels
High total iron binding
capacity
serum ferritrin levels
free erythrocytes
protophorphyrin

Iron supplements

In united state
Prevalence of 21,55
per 1000, mostly in
low income & minority
population, 1,8 % in
first trimester, 8,2 %
in second trimester,
and 27,4% in third
trimester

Risk factors :
Poor-diet
in
iron
rich
food
(clams,
oysters,liver,beef,shrimp,turkey,enrich breakfast cereals,
beans and lentils)
Poor-diet in iron absorption enhancer ( orange juice,
grapefruit, strawberries, broccoli, and peppers)
Rich-diet in food that diminish iron absorption (dairy
product, soy product, spinach, coffee and tea)
Gastrointestinal disease affecting absorption
Heavy mens
Short inter[regnancy intervals

Risk low birth

weight

Iron
deficiency
anemia in
pregnancy

Prematurity

Perinatal
mortality

Macrocytic anemia
Megaloblastic
anemia
(deficiency folat &
vitamin B12,
pernicious anemia)

Nonmegaloblastic
anemia (alcoholism,
liver disease,
myelodysplasia,
aplastic anemia,
hypothyroidsm, and
reticulocyte)

Charactheristic of mycrocytic anemia MCV > 100 fL

MCV > 115 fL deficiency folat or vitamin B12
Diet lacking of fresh leafy vegetables, legume or
mineral proteins, During pregnancy folic acid
requirement from 50 micrograms 400 micrograms
per day. Th/ folic acid 1 mg per day orally.
vitamin B12 deficiency women with gastric resection
1000 micrograms of vitamin B12 IM monthly.

Clinical Considerations &

Recommendations
Who should
be
screened?
How to
evaluate
asymptomati
c pregnant
women

All pregnant women

Iron deficiency should be
treated
Other anemia further
evaluation

Medical history, physical exam,

complete blood count, red blood
cel indices, serum iron level and
feritrin levels.
Pheripheral smear hemolytic
parasitic disease
Hgb electrophoresis iin some
ethnic group

Clinical Considerations &

Recommendations

Iron not
anemic
patient?
When
should
transfusio
n be
consider ?

Iron supplementation anemia

at delivery
Litle evidence iron result
mobidity beyond gastrointestinal
symptom

Transfusion of red blood cells are

seldom indicated in
hypovolemia (blood loss) or
operative delivery with anemic
patient
Antepartum complication by
transfusiion 24 %

Clinical Considerations &

Recommendations
When should
parenteral iron be
used in
pregnant patients?
Parenteral iron is used in
the rare patient ( cannot
tolerate of oral iron)
malabsorption syndrome
and severe iron
deficiency benefit from
parenteral therapy

Is there a role for

autologous
transfusion?
autologous transfusions
rarely performed, and the
inability to predict the
eventual need for
transfusion conclusion
that they are not costeffective

Summary of
Recommendations
&
Conclusions
Level
A
Level C
Recommendation
Iron supplementation
decreases the
prevalence of maternal
anemia at delivery

Level B Recommendation
Iron deficiency anemia
risk of low birth weight,
preterm delivery & perinatal
mortality.
Severe anemia (Hgb < 6
g/dL) abnormal fetal
oxygenation
(nonreassuring FHR,
amniotic fluid volume, fetal
cerebral vasodilatation&fetal
death maternal transfusion

Recommendation
All pregnant women should be
screened for anemia,iron
deficiency anemia treated
supplemental iron
Patients with anemia other
than iron deficiency anemia
further evaluated.
Failure to respond to iron
therapy further
investigation and may
suggest an incorrect
diagnosis, coexisting disease,
malabsorption,
noncompliance, or blood loss

Thank You