*Anaemia

Question 1

What is anaemia?

Answer 1

Reduction in the O2 carrying capacity of the blood

Question 2

What is anaemia caused by?

Answer 2

A decrease in RBC production
OR A reduction in Hb content of the blood
OR a combination of these

Iron deficiency anaemia:
- Reduced intake or absorption of iron
- Chronic infection
- Acute or chronic blood loss
- Excess demand such as frequent, numerous or multiple pregnancies

Question 3

What is the normal range for Hb?
Minimum Hb concentration <20 weeks and 20+ weeks?

Answer 3

110-140 g/L

0-20 weeks - 110 g/L
20+ weeks - 105 g/L

Severe anaemia <70 /L- requires urgent medical treatment
Very severe <40 - medical emerency due to risk of congestive heart failure and maternal death

Question 4

Physiological anaemia of pregnancy?

Answer 4

Maternal plasma volume expands by 50%
Total increase in RBCs by 25%
=haemodilution causing reduced Hb concentration

Question 5

Signs and symptoms of iron deficiency anaemia

Answer 5

Fatigue
Dizziness/fainting
Headache
Shortness of breath
Tachycardia
Pallor of mucous membranes
Palpitations

Question 6

What are some side effects of oral iron supplementation?

Answer 6

Black stool
Constipation
Indigestion
Sickness

Question 6

Absorption of iron is inhibited by

Answer 6

Tea, coffee, chocolate / cocoa drinks, red wine.

Question 7

Effects of iron deficiency anaemia

Answer 7

Reduced general health
Low resistance to infection
Increased minor disorders of pregnancy
In severe cases - intrauterine hypoxia
Increased perinatal mortality
APH or PPH more serious - reduce tolerance to blood loss
Higher risk of thromboembolic disorders
Increased risk of postnatal depression
Increased maternal mortality

Question 8

Management of iron deficiency anaemia

Answer 8

Regular iron supplementation
* 100-200mg ELEMENTAL IRON daily
* 1hr before or 2hrs after food
* Continue for 3-6 months after Hb/Ferritin are WNL

Recheck at 36 weeks
* FBP early in pregnancy and then at 28 weeks

Question 9

What is the normal recommended dose of folic acid daily?

Answer 9

0.4mg / day / 400 micrograms for first 12 weeks

Increased to 5-10mg when multiparity, multiples, haemoglocinopathies, diagnosed folate deficiency, previous neural tube defect

Question 10

What are some haem iron food sources?

Answer 10

• Lamb
• Beef
• Salmon
• Chicken
• Tuna
• Sardines
• Eggs

Animal foods

Question 11

What are some non-heam iron food sources?

Answer 11

• Tofu
• Oats
• Wholegrain cereals
• Chickpeas
• Dried fruit
• Brown rice
• Nuts
• Raw spinach

Question 12

Intravenous iron is more effective than oral iron, but may have the following adverse effects:

Answer 12

Skin itching and urticaria
Bronchospasm, dysponea
Back pain
Nausea, indigestion, abdominal pain
Headache
Hypotension
Tachycardia
Joint or muscle pain
Syncope
Circulatory collapse

Question 13

Absoprtion of iron is enhanced by

Answer 13

Vitamin C
Beef