Anaemia during pregnancy

Anemia pregnant levels are defined as Hb 11g% (less than 8% are considered severe) and below 35% of Ht.
 Pregnancy induces several changes in the balance fluidocoagulant: corpuscular volume growth (to a lesser extent, which would explain the apparent decrease in Ht), solicitation of iron and folic acid metabolism (cofactor required for the synthesis of DNA), etc..
 FrequentIs variable (25-75%) depending on the characteristics of the investigated population, socio-economic conditions, quality of prenatal care.
 EtiologyThey are known contributory factors: multiparity, prolonged lactation, multiple pregnancies, pre-pregnancy bleeding, food deficiencies, urinary tract infections.
 DiagnosisThe most frequently found pale skin and mucous membranes, fatigue, tachycardia, dyspnea, vertijele accompany severe forms.In folate deficiency is manifested by glossitis, subicterice states, vomiting, diarrhea, edema, proteinuria, fatigue.Iron deficiency is manifested initially by reducing deposits, stage reflected by serum ferritin levels of 15-20 mg / ml (normal 100 ± 50 mg / ml). Subsequently, serum iron drops (below 30 mg / ml), increased iron binding capacity and install anemia normochromic, normocytic (Hb less than 11g%, Ht 35%).
 The last step is hypochromic anemia, microcytic (hemoglobin below 10 g%, Ht below 33% Fe plasma in 30mg/ml, iron binding capacity than 400mg/ml, red blood cells small, round, pale).
 In practice, we use determinarileHb, Ht and serum Fe.Cauyate megaloblastic anemias of pregnancy are the deficiencies of folic acid (15-20% more common in twins). Hb recorded significant decreases (less than 5-6g%), red blood cells have values ​​of about 2 million macrocitoza, hipersegmentate leukocytes.
 Nutritional anemias may occur in areas with low economic standard, underfed, being the main protein deficiency. Blood picture is characterized by macrocitoza, normochromic, megaloblastoza, plus hypoproteinemia.Other forms of anemia during pregnancy are rare.
 PrognosisPregnancy always worsen existing anemia.Influence of anemia on the fetus is less significant in relation to risk of premature birth or weakness. Severe anemias favors fetal distress.Haemorrhage during delivery, or III, are felt more immediately lehuzia amid serious anemia in pregnancy (any severe anemia should be diagnosed and treated before birth).In lehuzie, infection and anemia increases the risk of thromboembolic disease.
TreatmentAdministration preparations based on iron, 180-200mg/zi, will continue after the correction of anemia for three months to restore iron stores. In about 10% of cases may develop gastrointestinal intolerance.Parenteral therapy, applied in cases with severe anemia or intolerance, im using paths or IM, 2 ml ampoules, 50 mg Fe / ml.The year the administration side effects may occur, situations in which transfusion is performed.Folic acid is administered at a dose of 20 mg daily in combination with iron preparations.Proteiprive anemia is corrected by treatment hiperprotidic, hydrolyzed protein, blood and plasma.