Anaemia In Pregnancy

Clinical description

Anaemia in pregnancy is defined as Hb < 11 g/dL (severe anaemia as Hb < 7 g/dL) at any gestational age.

Iron deficiency and acute blood loss are the most common causes of anaemia in pregnancy, but other causes should be considered with severe anaemia.

Signs and symptoms

History Easy fatigability, dizziness, headache, palpitations, PV bleeding Exam Pallor, tachycardia, +/- jaundice, +/- splenomegaly, +/- petechiae Investigations Point-of-care Hb to determine severity immediately; malaria RDT (or peripheral smear), stool for ova and parasites, FBC if Hb < 8 g/dL, HIV

Non-pharmacological

• Provide all antenatal women with FeFol 325 mg po BD
• Advise on diet rich in green leafy vegetables, liver, fish, eggs
• Give Albendazole 400 mg to prevent hookworm
• Give at least 3 doses SP (3 tablets, each tablet 500mg/25mg SP) 4 weeks apart, starting at13 weeks

gestation

• Advise to keep interval between pregnancy >2 years minimum
• All breastfeeding mothers should take iron supplements

Treatment

• Check FBC and treat according to the result
• If Hb < 7 g/dL, especially if symptomatic, then blood transfusion

 Transfuse rapidly if anaemia due to acute blood loss  Transfuse slowly if chronic anaemia (Consider use of diuretics as necessary to reduce risk ofcongestive cardiac failure due to sudden circulatory overload)  Treat with folate and FeFol 325 mg PO BD and recheckHb in 2-4 wks

• If MCV < 80, then send blood for iron studies (ferritin, TIBC and % saturation) if available.
• If MCV 80-93, then send blood for peripheral smear and consult haematologist as needed
• If MCV ≥ 94, then treat for folate or vitamin B12 deficiency
• Treat with Albendazole 400mg once on empty stomach
• Treat for malaria or schistosomiasis if indicated
• Mixed anaemia may occur and complicate laboratory findings
• If Iron deficiency, then treat with elemental iron 200 mg PO OD. Titrate upto reduce side effects and

encourage compliance.

• Take iron on emptystomach with vitamin C and without antacids.
• If Folate deficiency, then treat with folate 1-4 mg PO OD.
• If Vitamin B12 deficiency, then treat with vitamin B12 1000 mcg IM qweek x 4 weeks, then 1,000mcg IM

monthly or until deficiency is corrected.

• If haemolytic anaemia, then send blood for direct and indirect Coombs tests.
• Treat with corticosteroids.
• Drug-induced (i.e. methyldopa,penicillin, cephalosporin) haemolytic anaemia is typically milder

and istreated by stopping the offending medication.