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Sunday, 30 March 2002 05:30 PM GMT
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The pregnant woman needs 1000 mg iron all through pregnancy i.e. 3.5 mg/day
to maintain iron balance.
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Anemia in pregnancy is defined as hemoglobin concentration < 10 g/dl
during pregnancy and puerperium.
Introduction
The pregnant woman needs 1000 mg iron all through pregnancy i.e. a daily
amount of 3.5 mg to maintain iron balance.
The iron requirement in the latter half of pregnancy and for several weeks after
delivery increases to about 6-7 mg/day.
It is the most common form of
anemia encountered during pregnancy. The incidence is higher in poorly nourished women of low socioeconomic standard.
Causes
- Depletion of iron stores as occurs in non-supplementation of diet.
- Multifetal pregnancy
- Deficient absorption e.g. achlorhydria
- Bleeding with pregnancy or ankylostoma infestation
Diagnosis
Symptoms
- Weakness, loss of concentration
- Headache and loss of appetite
- Dyspnea and palpitations
Examination
- Pallor (nails, lips, conjunctiva)
- Pulse: tachycardia and waterhammer pulse
- Cardiac examination: systolic murmurs
- Abdominal examination: splenomegaly
Investigations
Complete blood picture shows a picture of hypochromic microcytic anemia:
- Low RBC count and hemoglobin
- Color index and MCHC are decreased
- WBC and platelets are normal
Serum iron is decreased
Treatment
Prophylaxis
Iron supplementation during pregnancy (30-60 mg/day and doubled in the case
of twin pregnancy)
Therapeutic treatment
- Diet rich in iron
- Oral iron therapy: Iron sulphate, iron gluconate
- Dose 300 mg tablet tds.
- Side effects include
constipation with dark stools, nausea and vomiting.
- Response: Hemoglobin is expected to increase with this therapy
at a rate of about 0.3-1 g per week and is continued till the hemoglobin
concentration is normalized.
The dose is then is reduced to half of the required dose in order to restore the iron stores.
- Parentral iron
A simple method to calculate the needed dose is to give 250 mg elemental iron for each 1 gram hemoglobin below
normal.
- Indications:
- Severe iron deficiency anemia when there is a need for a rapid response
- side effects during oral iron therapy.
- Patients who can not absorb iron e.g. malabsorption syndrome.
- Administaration:
Iron dextran (imferon) contains 50 mg/ml and could be administered by IV and IM
routes.
- Precautions:
- Sensitivity test must be done first with antihistaminic and corticosteroid ampoule.
- The maximum dose recommended by the manufacturer is 2 ml (lOOmg)/day
- Side effects:
Parentral iron is expensive and hazardous when compared with oral therapy. Side
effects include; pain, inflammation, phlebitis, fever, arthralgia, hypotension and may be fatal anaphylaxis
- Blood transfusion
Each blood unit raises the hemoglobin % by O.51 gram.
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