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ANEMIA IN PREGNANCY
Definitions:
 Anemia in pregnancy is often defined as a hemoglobin measurement below 10 g/dL
or hematocrit below 30%
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5 g/dL in the second trimester
...

 A hemoglobin of less than 11 g/dL or a hematocrit of less than 33% should be
investigated and treated to avoid blood transfusion and its related complications
 A pregnant woman will lose blood during delivery and the puerperium, and an
anemic woman is therefore at increased jeopardy
...

 It results from deficiency of iron, folic acid, or vitamin B12
...

 Other anemias occurring during pregnancy are aplastic anemia and drug-induced
hemolytic anemia
...

 Prevention through optimal nutrition and iron and folic acid supplementation is
desirable
...

 During pregnancy, the blood volume increases by about 50% and the red blood cell
mass by about 25%
 This physiologic hydremia of pregnancy will lower the hematocrit but does not truly
represent anemia
...

 This results in a physiologically lowered hemoglobin (Hb) level, hematocrit (Hct)
value, and red blood cell (RBC) count, but it has no effect on the mean corpuscular
volume (MCV)
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2
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4
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6
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2
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4
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Iron Deficiency Anemia
Introduction:
 Iron deficiency is responsible for about 95% of the anemias during pregnancy,
reflecting the increased demands for iron
Etiology:
 The two most common causes of anemia during pregnancy and the puerperium are
iron deficiency and acute blood loss
 A woman who is pregnant often has insufficient iron stores to meet the demands of
pregnancy
...

 Many women enter pregnancy with low iron stores resulting from heavy menstrual
periods, previous pregnancies, breast feeding, or poor nutrition
...

 True anemia is common, mainly because of the demands of the developing fetus on
iron and folic acid, particularly during the later months of pregnancy
...

Pathogenesis:

 Red cells may not become hypo-chromic and microcytic until the hematocrit has
fallen significantly
...

Treatment:
 Simple iron compounds: ferrous sulfate, fumarate, or gluconate
 The most appropriate oral iron therapy is use of a tablet containing ferrous salts,
such as:
 Ferrous fumarate — 106 mg elemental iron/tablet
 Ferrous sulfate — 65 mg elemental iron/tablet
 Ferrous gluconate — 28 to 36 mg iron/tablet
 Treatment consists of a diet containing iron-rich foods and 60 mg of elemental iron
(e
...
300 mg of ferrous sulfate) three times a day with meals
 The recommended daily dose for the treatment of iron deficiency in adults is in the
range of 150 to 200 mg/day of elemental iron; there is no evidence that one iron
preparation is more effective than another
...

 This regimen should lead to a modest reticulocytosis beginning in approximately
seven days and a rise in the hemoglobin concentration of approximately 2 g/dL over
the ensuing three weeks
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 Iron is best absorbed if taken with a source of vitamin C (raw fruits and vegetables,
lightly cooked greens)
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 If the woman cannot or will not take oral iron preparations, then parenteral therapy
is given
 Iron dextran (INFeD, Dexferrum), which contains 50 mg of elemental iron/mL can be
given either IM or IV
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Folic Acid Deficiency Anemia

Definitions:
 In the "classic" case of vitamin B12 (cobalamin, cbl) or folic acid (Vitamin B9)
deficiency, the patient presents with a severe macrocytic anemia (red blood cell
mean corpuscular volume (MCV) >100 fL, and often >115 fl), a low to low-normal
absolute reticulocyte count, and a characteristic blood smear showing
macroovalocytes, occasional megaloblasts, and hypersegmented neutrophils
(greater than five percent of neutrophils with five or more lobes or 1 percent with
six or more lobes)
 Folic acid deficiency anemia is the main cause of macrocytic anemia in pregnancy,
since vitamin B12 deficiency anemia is rare in the childbearing years
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4 mg to 0
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Etiology:





Twin pregnancies
Infections
Malabsorption
Use of anticonvulsant drugs such as phenytoin can precipitate folic acid deficiency
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 The diagnosis is made by finding macrocytic red cells and hypersegmented
neutrophils in a blood smear
Treatment:
 Because the deficiency is hard to diagnose and folate intake is inadequate in some
socioeconomic groups, 0
...

 A dose of 1 mg/day is usually sufficient, even if malabsorption is present
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 Cooking and storage of food destroy folic acid
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 Pernicious anemia (PA) is typically treated with parenteral (i
...
intramuscular) Cbl, in
a dose of 1000 µg (1 mg) every day for one week, followed by 1 mg every week for

four weeks and then, if the underlying disorder persists, as in PA, 1 mg every month
for the remainder of the patient's life
...
1 mg/d for 1 week, followed by 6
weeks of continued therapy to reach a total administration of 2 mg
 Folate deficiency is much less common than iron deficiency; however, taking 0
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 Patients with a history of neural tube defect should take 4 mg/d
...
Sickle Cell Anemia
 Women with sickle cell anemia are subject to serious complications in pregnancy
...

 Complications include infections, bone pain, pulmonary infarction, congestive heart
failure, and preeclampsia
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 Women with sickle cell trait alone usually have an uncomplicated gestation except
for an increased risk of urinary tract infection
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 Anemia may be associated with fetal growth restriction, this may lead to adult
cardiovascular disease has provided evidence that maternal anemia influences
placental vascularization by altering angiogenesis during early pregnancy

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