User:Wojcickij/Anemia in pregnancy

The most useful test with which to render a diagnosis of anemia is a low RBC count, however hemoglobin and hematocrit values are most commonly used in making the initial diagnosis of anemia. Testing involved in diagnosing anemia in the pregnant woman must be tailored to each individual patient. Suggested tests include: hemoglobin and hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), erythrocyte count, red cell distribution width (RDW), reticulocyte count, and a peripheral smear to assess red blood cell morphology. If iron deficiency is suspected, additional tests such as: serum iron, total iron-binding capacity (TIBC), transferrin saturation, and plasma or serum ferritin may be warranted. It is important to note that references ranges for these values are often not the same for pregnant women. Additionally, laboratory values for pregnancy often change throughout the duration of a woman’s gestation. For example, the reference values for what level of hemoglobin is considered anemic varies in each trimester of pregnancy.

- First trimester hemoglobin < 11 g/dL

- Second trimester hemoglobin < 10.5 g/dL

- Third trimester hemoglobin < 11 g/dL

- Postpartum hemoglobin < 10 g/dL

Causes
In the simplest of terms, anemia results from impaired production of red blood cells, increased destruction of red blood cells or blood loss. Anemia can be congenital (ie, conditions such as sickle cell anemia and thalassemia) or acquired (ie, conditions such as iron deficiency anemia or anemia as a result of an infection). The causes of anemia during pregnancy can be subdivided into two main categories; physiologic and non-physiologic causes.

 Physiologic Causes 

Dilutional anemia: There is an increase in overall blood volume during pregnancy, and even though there is an increase in overall red blood cell mass, the increase in the other parts of the blood like plasma decrease the overall percentage of redblood cells in

circulation.

 Non-physiologic Causes 

Iron deficiency anemia: this can occur from the increased production of red blood cells, which requires a lot of iron and also from inadequate intake of iron, which increase in pregnancy.

Hemoglobinopathies: Thalassemia and sickle cell disease.

Dietary deficiencies: Folate and Vitamin B12 deficiency are common causes of anemia in pregnancy. Folate deficiency occurs due to diets low in lefty green vegetables, and animal sources of protein. B12 deficiency tends to be more common in individuals

with Chron's disease or gastrectomies.

Cell membrane disorders: Hereditary spherocytosis

Autoimmune causes: lead to the hemolysis of red blood cells(Ex: autoimmune hemolytic anemia).

Hypothyroidism and chronic kidney disease

Parasitic infestations: some examples are hookworm or Plasmodium species

Bacterial or viral infections

Iron deficiency is the most common cause of anemia in the pregnant woman. During pregnancy, the average total iron requirement is about 1200 mg per day for a 55 kg woman. This iron is used for the increase in red cell mass, placental needs and fetal growth. About 40% of women start their pregnancy with low to absent iron stores and up to 90% have iron stores insufficient to meet the increased iron requirements during pregnancy and the postpartum period.

The majority of women presenting with postpartum anemia have pre-delivery iron deficiency anemia or iron deficiency anemia combined with acute blood loss during delivery.

Symptoms:

 Common Symptoms   : 

Headache, fatigue, lethargy, tachycardia, tachypnea, paresthesia, pallor, glossitis and cheilitis

 Severe Symptomss 

Congestive heart failure, placenta previa, abruptio placenta, operative delivery