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AHMED ABDULWAHAB
pregnancy.
Physiological changes.
Plasma volume increase by 50%.
Red cell mass increase by 25%.
Fall in Hb concentration and haematocrit
due to haemodilution.
MCV increase secondary to erythropoiesis.
Cont,
MCHC remain stable.
Serum iron and ferritin decrease because of
utilization .
Total iron binding capacity increases TIBC
Iron requirement increases total of 1000mg in
whole pregnancy.
Moderate increase in iron absorption .
Folate requirement increases
DEFINTION..
WHO recommended that Hb
CLINICAL FEATURE.
Often asymptomatic.
Diagnosed in routine screening .
Other ,tiredness, dizziness ,fainting ,
pallor may be apparent
SCREENING .
Routine screened by Hb
MCV . MCHC.
Etiology .
Increase demand in pregnancy due to
expanding red cell mass, fetal requirement
.If iron stores are depleted because of
menstruation , recurrent pregnancy ,poor
intake , anemia develops rapidly
CONSEQUENCES .
Preterm labor.
Infection
Medical intervention during labor .
Post partum blood loss.
? IUGR.
TREATMENT.
Oral iron is effective when there is time .
Hb increase 0.8 g/dl per week
Ferrous salt is better absorbed than the
ferric form .
Side effect depends on the amount of the
of the elemental iron .
Choice depends on cost and patient
tolerance .
Cont.
Vitamin C helps absorption .
Main side effect are gastro intestinal ,
gastric upset and constipation .
Indication for parenteral thereby .
Lack of compliance , severe GIT side
effect, mal absorption
Intera muscular iron sorbitol
Cont.
Deep im it is painful cause discoloration
of the skin .
High level may be excreted before
utilization .
IV IRON .
Iron saccharate cause more rapid rise in
Hb and has fewer side effect. Compared
Cont
To oral iron but more invasive , need
Cont.
Prevention is possible with good balanced
diet .
Identification and treatment of iron
deficiency prior to pregnancy are optimal .
Routine iron supplementation in pregnancy
improve in hematological indices.