BLOOD VOLUME

 Increases by 30%
 50% rise in plasma volume
+
20% rise in erythrocyte volume
 Increased in multiple
pregnancy, hydatidiform mole
 Decreased in abortion, stillbirth
PURPOSE
 Fill up enlarged uterus and its
hypertrophied vessels
 Meet fetal demands
 Protect mother against blood loss
 Protect fetus against impaired
venous return ( like in supine posture)
PLASMA VOLUME
 Starts at 6 weeks
 Most rapid in second trimester
 Plateaus around 32 weeks
 Total increase 50% (ml)
ERYTHROCYTE VOLUME
 Starts at 10 weeks
 Peaks in second trimester
 Continues till term
 Total increase 20% (250 ml)
 60

50

40

30

20

10

0
plasma RBC blood

Physiological anemia of pregnancy

results
 Physiological anemia ( 11-12 mg/dl) as
against a normal 12-16mg/dl
 Fall in erythrocyte count, hematocrit
 But total RBC volume increases
 MCH, MCV , MCHC normal
OTHERS
 leucocyte count increase( 20000-25000 ) at
labour and puerperium
 Platelet count increases
 Total serum protein and albumin decrease
 Immunoglobulins & fibrinogen increase
 Hypercoagulability as all factors except
2,11,13
 ANAEMIA IN PREGNANCY
 Most common complication
 Incidence in india- 40-90%
 Accounts for 10-15% of maternal
mortality
 Occurs when Hb conc goes below
11mg/dl (WHO) and 10mg/dl (FOGSI)
causes
Directly related to pregnancy
 Iron deficiency
 Folate /B12 deficiency
 anemia due to acute blood loss
 Anemia of chronic disease
 Pregnancy induced hemolytic anemia
 HELLP syndrome
anemia not directly related

All anemias are worsened in pregnancy

 Hemolytic anemias
 Hemoglobinopathies
 Aplastic anemia
IRON DEFICIENCY ANEMIA
 Most common
 Commonly due to malnutrition
 Others: parasite infestation, c/c blood
loss, malabsorption
 Microcytic hypochromic
 TOTAL IRON NEEDED: 1000 mg (fetus
300, mother Hb expansion 500, shed 200)
in addition to 150-200mg each for delivery
loss and lactation
An assesment..
 normal requirement in non pregnant
women:1-2 mg/day
 on average 5% of dietary iron absorbed
 So daily intake needed:20-22 mg/day
(marginal)
 Pregnancy requirement: 4-6mg/day
so required intake 40-60 mg/day
Scenario in india
 Low socioeconomic status
 Poor intake
 Vegetarian source(1% absorbed)
 Parasitic infestations
 Multiple pregnancies
 Other c/c diseases
 MEGALOBLASTIC ANEMIA
 Low plasma conc. and increased demand
for folic acid & vitamin B12
 macrocytic
 Folate Requirement in pregnancy: 400
microgram/day
 vitamin B12 -0.6-0.7 microgram/ day
others
 PIHA- rare, unexplained
 HELLP syndrome-
microangiopahic, follows severe
preecclampsia
 Anemia of a/c blood loss- normocytic
normochromic
 Anemia of c/c diseases-c/c renal
failiure, c/c infection, inflammatory
diseases, neoplasms (normocytic
normochromic )