Anemia In Pregnancy

Question 1

Past history

Answer 1

Melena,hemetemesis,piles,epistaxia,gi disorders
Bleeding tendency
Worm infestation,walking barefoot
Malnutrition,diarrhea,vomiting
Malaria,tb,rheumatoid arthritis
Epilepsy
Recurrent uti
Hemolytic anemia

Question 2

Family history

Answer 2

Sickle cell anemia
Thalassemia

Question 3

Normal values of MCV,mch,mchc

Answer 3

Mcv- 75-95 meu m cubed
Mch-26-31 pg
Mchc-34%

Question 4

Peripheral smear of IDA

Answer 4

Hypochromic,microcytic,anisocytosis,poikilocytosis

Question 5

Peripheral smear in megaloblastic anemia

Answer 5

Hyperchromic,macrocytic,hypersegmentation of neutrophils,presence of megaloblasts,Howell jolly bodies

Question 6

Target cells seen in

Answer 6

Thalasemia
Ida

Question 7

Presence of eosinophils

Answer 7

Hookworm infestation

Question 8

Presence of shistocutes in smear indicates

Answer 8

Hemolysis

Question 9

Normal platelet count

Answer 9

1.5-4 lakhs/ mm cube

Question 10

Platelets deficient in

Answer 10

Idiopathic thrombocytopenic purpura

Question 11

Normal total serum iron

Answer 11

65-120 meu g/ dl

Question 12

TIBC

Answer 12

300-400 meu g/ dl

Question 13

Normal serum ferritin

Answer 13

15-200 meu g/l

Question 14

Inv for anemia

Answer 14

HB,RBC,pcv
Peripheral smear
Platelet count
Reticulocyte count
Blood grp,rh type
Bleeding clotting time
Stool examination
Urine
Serum protein
Bone marrow study

Question 15

Causes of anemia

Answer 15

Nutritional- deficiency of iron,folic acid,vit b12
Due to inc destruction- hemolytic anemia,hemoglobinopathies,malaria
Due to blood loss- heavy menstrual bleeding,hook worm,gi bleeding,obstetric hemorrhage
Due to impaired production - aplastic anemia,chronic renal disease

Question 16

What is anemia

Answer 16

Decrease in oxygen carrying capacity of blood due to quantitative or qualitative decrease in RBC and hb concentration in blood

Question 17

ICMR classification of anemia

Answer 17

Mild-10-10.9 g/dl
Moderate-7-10
Severe-4-7
Very severe -<4

Question 18

FOGSI classification of anemia

Answer 18

Mild-8-10 g/dl
Moderate-6.5-8
Severe-<6.5

Question 19

Causes of increased iron requirement during pregnancy

Answer 19

Fetus,placenta-300 mg
Maternal hb mass expansion-500 mg,loss by excretion-200 mg
Parturition and lactation-300 mg
Conservation of iron due to amenorrhea -300 mg
Total requirment -1000 mg

Question 20

Physiological anemia in pregnancy

Answer 20

Hemodilution,results in decrease in hb concentration

Question 21

Criteria for physiological anemia

Answer 21

Lower limit of hb-10 g/dl
Lower limit of rbc-3.2 mill/ml
Lower limit of pcv-30%
Normal peripheral smear

Question 22

Anemia prophylaxis

Answer 22

Prophylactic dose of 100 mg elemental iron and 0.5 mg folic acid at least 10/ days after first trimester,from 14-26 weeks,to be repeated 100 days after post partum

Question 23

Calculation of iron requirement

Answer 23

2.4× wt in kg× hb def in gm+ 1000 mg(to replenish stores)

Question 24

Stages of iron deficiency

Answer 24

First stage- depletion of iron stores,decrease in ferritin
Second- decrease in serum iron and increase in TIBC
third - IDA

Question 25

Effect of anemia in fetus

Answer 25

Low birth wt Iugr Pre term Iud Asphyxia Feeding difficulty

Question 26

Antenatal anemia treatment

Answer 26

Oral iron- pregnancy<30 weeks,mild and moderate anemia Parenteral iron- 30-36 weeks,moderate anemia Packed RBC transfusion->36 weeks,severe anemia, hemoglobinopathies,acute blood loss

Question 27

Parenteral iron- preparations

Answer 27

Iron dextran Iron sorbitol citric acid Iron sucrose(dose, 100 mg in 100 ml of normal saline iv in 15 min/ day)

Question 28

Daily requirment of iron

Answer 28

Non pregnant women -2-3 mg a day Pregnant-6-7 mg a day

Question 29

Factors that decrease iron absorption

Answer 29

Phytates Tannins Phosphates Calcium Milk Tea Antacids Ppi

Question 30

Factors that increase iron absorption

Answer 30

Vit c Amino acids Citric acid

Question 31

Daily requirment of folic acid

Answer 31

500 microgram a day

Question 32

Complications in pregnancy

Answer 32

Cardiac failure Subinvolution of uterus Cortical vein thrombosis DVT Morbidity and mortality

Question 33

Types of hemolytic anemia

Answer 33

Hereditary . Hereditary spherocytosis . Hemoglobinopathies . Glucose 6 phosphate def Acquired . Paroxysmal nocturnal hemoglobinuria

Question 34

Hemoglobinopathies

Answer 34

Sickle cell Thalasemia Spherocytosis

Question 35

Complaints in anemia

Answer 35

Lethargy Fatigue Swelling of face,arms,abdomen,feet Palpitation Breathlessness Chest pain