Iron Deficiency Anemia with Pregnancy

Question 1

WHO hemoglobin range to diagnose anemia

Answer 1

• below 120 g/l in nonpregnant women.
• below 110 g/l in pregnancy.

Question 2

Percent of pregnant women experience Anemia

Answer 2

30% of nonpregnant women
40% of pregnant women experience anaemia.

Question 3

The most common cause of anaemia worldwide is

Answer 3

iron deficiency, accounting for at least 50% of cases.

Question 4

Why iron is important for human body

Answer 4

• DNA synthesis
• cell proliferation
• energy production, because it has a unique ability to mediate electron transfer (either reduction or oxidation) in enzymatic reactions.

Question 5

Where is iron located in the body

Answer 5

1. About 2/3 of the body’s iron is found in haemoglobin
2. the remainder stored as ferritin and hemosiderin in the liver and reticuloendothelial system.

Question 6

How is iron levels regulated

Answer 6

• is controlled by hepcidin, a peptide hormone mainly synthesised in the liver.
• Hepcidin is crucial for regulating gut iron absorption and erythrocyte recycling.

Question 7

What affect levels hepcidin

Answer 7

• It increases in response to high circulating and tissue levels of iron.
• it decreases in tissue hypoxia, iron deficiency and increased erythropoietic activity as a result of inhibited transcription.

Question 8

Iron distribution

Answer 8

3–4 g total body iron
* 1–2 mg iron is lost daily.
* 1 mg is lost during menstruation each month.
* Absorption in the gut is limited to 1–2 mg/day to replace iron loss, but can increase at times of need.
* Recycling of haem from aged erythrocytes generates approximately 40–60 mg iron/day, which is key to maintaining iron requirements.

Question 9

What happens if iron has been taken up by enterocytes but is not required?

Answer 9

hepcidin prevents entry of iron into the circulation by reducing the expression of ferroportin, Iron therefore remains in the enterocyte and is lost when these cells are sloughed off.

Question 10

What is ferroportin?

Answer 10

transmembrane protein that transports iron from the inside to the outside of a cell.

Question 11

Hepicidin action in acute blood loss

Answer 11

If there is acute blood loss, hepcidin production decreases, which increases importation of iron by ferroportin

Question 12

What is Hepicidin

Answer 12

5-amino acid peptide hormone that regulates iron uptake and release from stores in response to circulating and tissue levels of iron.

Question 13

main storage protein for iron

Answer 13

Ferritin
Found in all cells and bodily fluids, the highest concentration being found in hepatocytes.

Question 14

Blood loss effect on iron

Answer 14

For every millilitre of blood
lost, 0.5 mg iron is lost.

Question 15

In postmenopausal women, the most common cause of anaemia is

Answer 15

blood loss from the gastrointestinal tract.

Question 16

In premenopausal women from high-income countries, the most common cause of iron deficiency and iron-deficiency anaemia is

Answer 16

menstrual blood loss

Question 17

HMB accounts forwhat percent of cases of iron-deficiency anaemia

Answer 17

20–30%

Question 18

FIGO PALM-COEIN classification for abnormal uterine bleeding

Answer 18

Structural causes:
● P – Polyp
● A – Adenomyosis
● L – Leiomyoma
● M–Malignancy and hyperplasia
Unrelated to structural abnormality:
● C – Coagulopathy
● O – Ovulatory dysfunction E – Endometrial
● I – Iatrogenic
● N – Not otherwise classified

Question 19

obese women may be at risk of iron deficiency and iron-deficiency anaemia through

Answer 19

locally produced proinflammatory cytokines from obese adipose tissue.

Question 20

The recommended daily intake of iron for women in their reproductive years is

Answer 20

18 mg/day
although the median is 12 mg to combat loss due to menstruation.

Question 21

Pregnancy iron requirement

Answer 21

1200 mg

Question 22

What is maternal erythrocyte mass
increase in pregnancy

Answer 22

from 350 ml to 450 ml.

Question 23

Classic symptoms of iron deficiency and iron-deficiency anaemia include

Answer 23

• fatigue
• weakness
• irritability
• hair loss
• poor concentration

● Furthermore, shortness of breath on exertion, palpitations, tongue discomfort, disturbance of taste, pruritus, headaches and tinnitus can occur.

Question 24

Symptoms of severe iron deficiency including

Answer 24

• shortness of breath at rest
• angina
• ankle oedema

Question 25

Severe deficiency typically appears at what Hb level

Answer 25

when haemoglobin is less than 70 g/l, unless there is coexisting cardiorespiratory disease.

Question 26

Signs of iron-deficiency anaemia include

Answer 26

1. pallor
2. koilonychia (spoon-shaped nails with longitudinal ridges)
3. angular cheilitis (ulceration at the corners of the mouth)
4. atrophic glossitis (loss of tongue papillae, tongue typically appears dark red).

Question 27

Sever iron deficiency anemia cardiac signs

Answer 27

• tachycardia
• cardiac murmur
• cardiac enlargement
• ankle oedema
• heart failure

All can be detected

Question 28

What is iron deficiency

Answer 28

A relative or absolute depletion of body iron. Stores are particularly affected and inadequate to maintain the demands for erythropoiesis

Question 29

What is iron deficiency anemia

Answer 29

Reduced amount of haemoglobin or number of erythrocytes because of insufficient iron for erythropoiesis

Question 30

What is Iron-restricted erythropoiesis

Answer 30

Reduced supply of iron for erythropoiesis, irrespective of iron stores

Question 31

Iron-restricted erythropoiesis

Answer 31

Reduced supply of iron for erythropoiesis, irrespective of iron stores

Question 32

Functional iron deficiency

Answer 32

Erythroid iron not readily accessible despite increased requests and apparently adequate body iron stores. Associated with chronic disease, inflammatory conditions and malignancy

Question 33

Ferric iron (Fe2+) and ferrous iron (Fe3+)

Answer 33

non-haem iron from cereal and vegetable sources contains ferrous and ferric forms of iron.
The ferrous form is better absorbed from the gut therefore the ferric iron is reduced to ferrous iron by stomach acid, ascorbic acid and enzymes.

Question 34

What is transferrin

Answer 34

Iron-binding protein mostly produced by the liver which acts as an intercellular transporter for iron. Approximately 3 mg total body iron is bound to transferrin at any one time.

Question 35

anaemia for those living at sea level

Answer 35

HB < than 130 g/I in men
< 120 g/I in women aged 15 y and over
<110 g/I in pregnant women.

Question 36

Blood profile of Iron deficiency

Answer 36

microcytic, hypochromic red cells
reduced mean corpuscular volume reduced mean corpuscular haemoglobin.

Question 37

Most reliable indicator for iron deficiency

Answer 37

Serum ferritin

in the absence of inflammation or chronic disease.

Question 38

Serum ferritin level that indicates iron deficiency

Answer 38

Serum ferritin levels <15 ng/ml (33.70 pmol/I)

Question 39

Antenatal care screening fir iron deficinecy

Answer 39

At booking and 28 weeks

Question 40

Serum ferritin levels during pregnancy

Answer 40

Ferritin rises initially and then gradually declines as pregnancy continues so that by 32 weeks levels are 50% less than prepregnancy levels.

Treatment should be instigated when levels fall below 30 mcg/I.

Question 41

Mild iron deficiency anemia

Answer 41

Non pregnant: 110-119
Pregnant: 100-109

Question 42

Moderate iron deficiency anemia

Answer 42

Non pregnant: 80-109
Pregnant: 70-99

Question 43

Severe iron deficiency anemia

Answer 43

Non pregnant: <80
Pregnant:<70