Peak of physiological anemia is in 30-32 weeks so need repeat hb testing as pregnancy continious.
IDA is the most common type of anemia.
Why hb reduce during pregnancy? hemodiltuiont + for growth!
why iron started only in second trimester? 1. iron stores for first trimester 2 less needed for first trimester 3. have nasea and vomitting etc so reduce the already having gi effects in first trimester
physiological anemmia in oregancy.
so how to diagnose pathological anemia and threatening hb levels?
for all women can take prophylactic iron bt if falls less than 11 then must take therapeutic iron dosages and investigate the case as well.
Risk factors for ida in pregnancy = can multiparous with little age gaps between pregancies can be risk factor.
Always for any pregancy or obsgyn case, useful to ask for history of blood transfusion and reason for the blod transfusion
can point to etiology eg repeated blood transfusion points to thalassemia or haemoglobinopathies
qantify the pallow as well ⇒ like conjuctiva is mild. tongue and palms moderate and severe.
Negative findings of importace shold be emphasized.
If important if positive then important if negative too.
can have ida and coexisting folate defiiciency anemia as well. so be carefl.
HPLC = high performance liquid chromatography will tell you percentage of hbA hbS etc . Its a confirmatory test, not a screening test. screening test should be cheap.
nestroft is like a screening osmotic fragility test. just screening not confirmatory. high false positives. bt less false negatives.
HPLC will qantify the levels of the different hbs. hb electropheoresis on the other hand is a qualitative test.
nastroft vs osmotic fragility test vs sickling test vs hb electropheresis vs hplc
Dont say that entire dependant on automated reports and machine estimated ones. you can even cont.
in between meals ⇒ an hour before or an hour after
iron studies can be used to distinguish ida from thalassemia and other related
If failed, and stll ida, then can give other formulations or go for parenteral. parenteral is better becase other formations are expsneive and compliance still in doubt.
not that parenteral increases hb faster...nope..the only reason why we give in severe anemia is to insure compliance.
the ltimate way to differienciate is by hplc but can use iron studies to begin to diffrienciate as well.
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2.2 mg per hamoglobin change per body weight kg + 1000mg body stores
Earlier iron dextran was sed. bt had more reactions, so not used anymore.
Very painful ⇒ thats why was used on the bottox. Now we have better alternatives.
can change formulations if not responsive - but better parenteral because government provides parenteral free.
Parenteral iron is contraindicated in haemoglobinopathies.
VIT B 12 CAN BE given with iron. but give vit b12 only with folic acid. Dont give vit b 12 alone = always combine with folic acid otherwise thats deficiency will be created.
Anemia in pregancy
Anemia in pregnancy case
