anaema in pregnancy.docVIP

Anemia in prengancy Anemia is a significant maternal problem during pregnancy.A hemoglobin of less than 110 g/l or a henatocrit of less than 33% should be investigated and created to avoid blood transfusion and it’s related complications.A pregnant woman will lose blood during delivery and the puerperium,and an anemic woman is therefore at increased jeopardy.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. Nutritional anemia is the most common form.It esults from deficiency of iron,folic acid,or vitamin B12。Pernicious anemia due to vitamin B12 deficiendcy almost never occurs during pregnancy.Orher anemiaa occurring during pregnancy are aplastic anemia and drug-induced hemolytic anemia. Iron deficiency anemia Iron deficiency is responsible for about 95% of the anemias during pregnancy,reflecting the increased demands for iron.The total body iron consists mostly of iron in hemoglobin(about 70% of total iron;about 1700 mg in a 56-kg woman)and iron stored as ferritin and hemosiderin in reticuloendothelial cells in bone marrow,the spleen,and parenchymal cells of the liver(about 300 mg).Small amounts of iron exist in myoglobin,plasma,and various enzymes.Hemosiderin contains 37% more iron than does ferritin. Absence of hemosiderin in the bone marrow indicates that iron stores are exhausted.This is both diagnostic of anemia and one of the earliest signs of iron deficiency.This will be followed by a decrease in serum iron and an increase in serum total iron binding capacity and anemia. During the first half of pregnancy,iron requirements may mot be increased significantly,and iron from food(10-15mg/d)is sufficient to cover the basal loss of 1mg/d.However,in the second half of pregnancy,iron requiremnets increase due to expansion of red blood cell mass and rapid growth of the fetus.Increased numbers of red blood cells and agre