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Anaemia And Haemoglobinopathies Flashcards

(58 cards)

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1
Q

What are the 6 types of anemia

A

Iron deficiency
Folate deficiency
B12 defiency
Inheritses haemolytic
Acquired haemolytic
Thalasseamia

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2
Q

What is inherited haemolytic

A

Inherited blood condition that occurs when your red blood cells are destroyed faster than they can be replaced

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3
Q

Acquired haemolytic anaemia

A

Developed condition

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4
Q

Thalasseamia

A

Inherited conditions that affect haemoglobin

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5
Q

What is anaemia

A

Condition where the number size or hb content of RBC is decreased

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6
Q

Definition of anaemia in pregnancy

A

Iron defiency anaemia - low serum ferritin conc of more less than 30ug/L
Haemoglobin of
less than 110 1st trimester
Less than 105 2nd and 3rd
Less than 100g postpartum
Anaemi is treated when accompanied by depleted iron sores plus signs of a comprimesed supply of iron to the tissues

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7
Q

Prevalence of anaemia i 2019

A

Globally Pregnant women- 36.5%
Globally Children - 39.8
African countries - children 60.2%

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8
Q

Balance of iron stores

A

Iron is saved in pregnancy through increased absorption, moblistaionof iron stores and lack of menses
Vs
Iron is lost sure to additional iron requirements for increase in erythrocytes stored in the placenta and fetal needs in pregnancy
Iron lost as birth but is required for lactation

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9
Q

Total mean iron requirement of pregnancy

A

1000-1310mg

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10
Q

What is the mean iron requirement due to

A

Increase in maternal red cell mass 500mg
Foetus 300mg
Placenta 35-100mg
Insensible ls through urine stools and skin 200mg

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11
Q

When do most iron requirements occur

A

In the lat 20/40 averaging 6-7mg per day
Placenta will ensure iron gets to the foetus despite maternal levels

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12
Q

What is mean cell volume

A

Are mean vol of a red cell fluctuates in non- preganant rangee 77-79 femolitres
Sensitive measurement of iron status in pregnancy

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13
Q

What happens in normal pregnancy in red cell size

A

Increases

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14
Q

Wat happens tto red cells size with true iron deficiency anaemia

A

Reduced

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15
Q

Mean cell haemoglobin

A

Average amount of hb in red cell fall with non pregnant range of 26-32 picograms
Indicates how well filled the cells are with Hb and falls within the normal on pregnant range of 32- 360g/L
No real change in pregnancy

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16
Q

Packed cell volume

A

Aka Hct haematocrit
Falls from 0.45-0.33L/L (45%-33%)

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17
Q

What happens to ferrotin levels in pregnancy

A

Fall
90 macrograms/L 1st trimester
30macrograms/L 2nd trimester Less than
15 macrograms/L 3rd trimester

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18
Q

What happens to maternal circulating plasma volume

A

Increase up to 50% by 32-34/40 a likely total increase of 1200ml by term

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19
Q

Physiological anaemia
Why does RBC increase by 18-25%

A

Due to 3 fold rise in erythropoietin in 2nd trimester due to progesterone prolactin and human placental lactogen influences
Conc of RBC reduces from 4.2x10^12 to 3.8x10^12/L by term

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20
Q

Physiological anaemia
What does Rise in plasma % compared to RBC % rise causes

A

haemodilution in pregnancy
This causes a fall in Hb concentration, reaches a nadir in. 2nd trimester (when plasma expansion as its greatest and rises in 3rd
This is not pathological and does not require treatment or supplementation
Hb may drop 2g/L in pregnancy
Treatment of serial Hb less than 100g/L r progressive reduction of MCV should be treated

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21
Q

What percentage if the rich world women have true iron defiency anaemia

A

2%

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22
Q

What % poor world women have true iron defiency

A

Up to 50% contributing to High mortality rates
Iron defiency anaemia + folic acid + vitB12 deficiencies

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23
Q

General causes of iron defieicny anaemia

A

Inadequate intake of iron - diet
Poor absorption of iron - malabsorption
Loss of iron due to parasitic infections
Blood loss
Diseases such as colitis
Certain medications (ranitidine, omeprazole)

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24
Q

Which women should we identify at risk at booking history

Study These Flashcards
A

Reduced food intake malnutrition
Excessively heavy menstruation
Short pregnancy gap
Previous APH/PPH
Multiple pregnancies
Low socioeconomic groups
Inherited haemoglopbinopathies

25
Causes of anaemia in pregnancy
Ruptured ectopic pregnancy APH PPH Ion deprivation from pregnancy - heavy menstrual flow Amoebic dysentery Malaria Clostridium Welch’s causing haemolysisi Hook worm Bilharzia Dietary defiency of iron Excess demands - multiple pregnancy Chronic inflammation - recent UTIs/ chronic kidney disease Threatened and spontaneous miscarriage Bleeding haemorrhoids Haemoglobinopathies (sickle cell, Thalasseamia)
26
Signs and symptoms of anaemia
Fatigue Giddiness Palpitations Shortness of breath Tachycardia Pallor Pale mucous membranes Loss of appetite Feeling cold Pica Oedema
27
Effects of anaemia on pregnancy
Lowered immunity Increased risk of infection APH/PPH risk increased Increased risk of postnatal depression
28
Effect of anaemia on fetus/baby
Intrauterine hypoxia Intrauterine growth restriction Low birth weight Pre them labour Or iron stores in 1st year of life Poor cognitive performance
29
Management of iron defiency anaemia
Diet Oral iron supplementation Paternteral iron supplementation Delayed cord clamping at delivery
30
Management diet
Haem iron - red meat, fish,poultry are all generally well absorbed Non haem iron - cereals pulses legumes dark leaf veg dried fruit Fortified cereals Fruit and veg rich in vit C that absorb iron - kiwis orange juice potatoes cauliflower broccoli
31
What foods inhibit absorption of iron absorption
Milk Eggs Tea Coffee Ran Oats Corn
32
What are the issues with diet management
Affordability Lifestyle changes Vegetarian diet
33
Iron defiency anaemia supplements
Ferrous sulphate tablets can be taken up to tds \iron content - 68mg per tablet Ferrous glauconite - 300mg tablet contains 35,g iron Ferrous fumarate - 322mg UHL guideline check hb after 2/40
34
How can you increase iron absorption
Maximise with orange juice Vit c ascorbic acid Unwanted effect nausea abdominal pain vomiting constipation black stools
35
Issues for iron supplement
Accidentally swallowed by children Better tolerated preparation are expensive Benefits for those who can afford them - pregnacare
36
Parental iron infusion
In 2nd trimester less than 34/40 or postpartum if intolerant non compliant fail to respond to oral iron or proven malabsorption IM no longer used Intravenous iron High risk of hypersentiviy anaphalytic shock Mandatory test dose - need cpr facilities Does depend on women weight and Hb
37
Contr indications
H/o anaphalixis Chronic infection Chronic liver disease Requires strict monitoring and ECG as can cause SVTs
38
What complications can anaemia bring I’d not treated
Low birthweight Premature labour and birth Stillbirth Higher risk of needing a blood transfusion in labour Reduced breast milk or chest milk supply Iron defiency i the first 33 months of your babys life Fatigue in the few months after birth Postnatal depression
39
How will iron deficiency affect women and baby
Low birthweight Premature birth and labour Stillbirth Higher risk of needing blood transfusion Reduced breast milk upply Iron def in first 3months of your babys life Fatigue Postnatal depression
40
Investigations for anaemia
Diet Lifestyle Blood test Hb levels MCV PCV Serum ferritin
41
Folate defiency anaemia
Folate essential for dna synthesis and cell duplication 3x increase in demand in pregnancy Folate stores only last of few weeks When depleted there is a elated maturation of the red blood cell in the nucleus in the bone marrow Red blood cells ar mis shapen and reduced survival time
42
What is folate defiency anaemia caused by
Poor diet - common in alcoholics Malabsorption syndromes Drugs Uk incidence - 0.5% Globally 1/3 pregnancies
43
Clinical signs and symptoms for folate defiency
Extreme tiredness Pins and needles Muscle weakness Depression
44
Associated risks of folate defiency
Miscarriage APH Preterm labour Neural tube defects
45
What are good sources 0f folate
Broccoli Sprouts Peas Asparagus Small mount in leafy green veg
46
Folate defiency anaemia intake
Recommend intake -50 dietary folate equivalent daily rises to 400 by day in pregnancy 5000 macrograms of folic acid for women with previously had a baby with a neural tube defect , taking meds for epilepsy, have diabetes or colleic disease Family history of neural tube defect should take a higher dose
47
Pernicious anaemia
Vit b12 defiency Helps form myelin Produce energy from metabolism of fat and protein Produce hb Vit b12 bound to protein in food Hydrochloric acid in stomach releases b12 from proteins during digestion PNE released vitamin b12 combines with gastric intrinsic factor The complex can then be absorbed by intestinal tract
48
Signs and symptoms of pernicious anaemia
Yellow tinge to skin Sore and red tongue Mouth ulcers Pins and needles Disturbed vision Irritability Decline in mental abilities
49
Sources of vit b12
Beef liver Salmon Cod Eggs Cheese
50
Treatments
Injections of vitb12 Life long treatment every 3months
51
Management of Thalasseamia
Preconcptual care Full blood count - HB and MCV Bone marrow Erlly pregnancy test - CVS Antenatal care Regular Hb and serum ferritin levels Risk of preterm labour Hypoxia of mother and fetus
52
Management of Thalasseamia in labour
Script monitoring of FH By Fluid balance Active management of 3rd stage
53
Management of Thalasseamia in postnatally
Observe for signs of infection and haemorrhage Anaemia Paediatric follow up Ongoing Periodic blood transfusion
54
Symptoms of sickle cell crisis
Pain Breathlessness Pallor Fever General weakness Vision problem
55
Triggers of sickle cell crisis
Infection Cold temp Dehydration Stress Exercise
56
Complications of sickle Cell crisis
Chronic anaemia Bone marrow suppression Thromboembolic disease - blood clots Cardiac failure Sudden death
57
Management of sickle cell
Pre conceptual - folic acid 5mg/day Antenatal - booking med history Obs/haem team Investigations- FBC, blood group, antibody,ferritin, hiv, renal and liver function and reticulocyte count. Aspirin Antibiotics
58
If mothers ar admitted - sickle cell
Low molecular weight heparin Vt d By O2 stats Asymptotic infection Acute chest symptoms 7-20% 3rd trimester - serial growth/doppler In labour there is a risk of sickle crisis Avoid prolonged labour Postnatal - risk of sickle crisis, PPH and dvt Neonatal screening - birth follow up electrophoresis 6 weeks to screen for Thalasseamia/ antibiotic from 3 months

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