Anaemia in Pregnancy Flashcards
What is anaemia?
Anaemia is defined as a low concentration of haemoglobin in the blood. This is the result of an underlying disease and is not a disease itself. The prefix an- means without, and the suffix –aemia relates to blood.
What is haemoglobin?
Haemoglobin is a protein found in red blood cells. It is responsible for picking up oxygen in the lungs and transporting it to the cells of the body. Iron is an essential ingredient in creating haemoglobin and forms part of the structure of the molecule.
During pregnancy, when are women screened for anaemia?
Women are routinely screened for anaemia twice during pregnancy:
- Booking clinic
- 28 weeks gestation
Why does anaemia occur in pregnancy?
During pregnancy, the plasma volume increases. This results in a reduction in the haemoglobin concentration. The blood is diluted due to the higher plasma volume.
How may anaemia in pregnancy present?
Often anaemia in pregnancy is asymptomatic. Women may have:
- Shortness of breath
- Fatigue
- Dizziness
- Pallor
What are the normal haemoglobin concentration in pregnancy at booking bloods, 28 weeks gesttaion and post partum?
Booking bloods: >110 g/l.
28 weeks gestation: >105 g/l.
Post partum: >100 g/l.
What parameter indicated the cause of anaemia in pregnancy?
The mean cell volume (MCV) can indicate the cause of the anaemia.
What is cause of low, normal and raise MCV anaemia?
Low MCV may indicate iron deficiency,.
Normal MCV may indicate a physiological anaemia due to the increased plasma volume of pregnancy.
Raised MCV may indicate B12 or folate deficiency.
Which conditions are screened for in haemoglobinopathy screening in pregnant women?
Women are offered haemoglobinopathy screening at the booking clinic for thalassaemia (all women) and sickle cell disease (women at higher risk). Both are causes of significant anaemia in pregnancy.
Other than MCV, what other investigations can be ordered for anaemia in pregnancy?
Additional investigations are not routinely performed, by may help establish the cause of the anaemia. They may include:
- Ferritin
- B12
- Folate
Briefly describe the use of iron in managing anaemia in pregnancy
Women with anaemia in pregnancy are started on iron replacement (e.g. ferrous sulphate 200mg three times daily). When women are not anaemic, but have a low ferritin (indicating low iron stores), they may be started on supplementary iron.
Briefly describe the use of B12 in managaing anaemia in pregnancy
The increased plasma volume and B12 requirements often result in a low B12 in pregnancy. Women with low B12 should be tested for pernicious anaemia (checking for intrinsic factor antibodies).
Advice should be sought from a haematologist regarding further investigations and treatment of low B12 in pregnancy. Treatment options for low B12 are:
- Intramuscular hydroxocobalamin injections
- Oral cyanocobalamin tablets
Briefly describe the use of folate in managing anaemia in pregnancy
All women should already be taking folic acid 400mcg per day. Women with folate deficiency are started on folic acid 5mg daily.
Briefly describe the management of thalassaemia and sickle cell anaemia in pregnancy
Women with a haemoglobinopathy will be managed jointly with a specialist haematologist. They require high dose folic acid (5mg), close monitoring and transfusions when required.
