- Anemia in Pregnancy
- Iron deficiency Anemia
- Folate and Vitamin B-12 Deficiency anemia
- Infectious causes of anemia
- Diamond-Blackfan anemia
- Sickle Cell Anemia
- Treatment of Sickle cell anemia
- Pregnant woman with Sickle Cell Anemia
- Thalassimias in Pregnancy
- Thalassemia in pregnancy
During pregnancy, the volume of blood increases. This causes ‘thinning’ of blood also known as hemodilution. As the body prepares itself to support the fetus, there is an increase in the amount of red blood cells and plasma volume. But as the rate of the increase in the red blood cells is less in comparison to that of the plasma, it can lead to anemia. The pathological results may show:
- Decrease in the level of hemoglobin
- Decrease in the hematocrit (Hct) value
- Decrease in RBC count.
The exact range that can qualify a pregnant woman as anemic is not exactly clear though most centers take it as is 10.5 g/dL. In a non-pregnant woman it is assumed to be 14g/Dl.
Even in pregnant women, there can be many types of anemia that occur due to different causes.
Some of the most common ones are:
- Iron deficiency anemia
- Folate and Vitamin B-12 Deficiency anemia
- Infectious causes of Anemia
- Diamond-Blackfan anemia
- Sickle Cell Anemia
Iron deficiency Anemia
Iron deficiency anemia is one the most common types of anemia which occurs in 75-95 % of women who report anemia. During pregnancy, the demand for iron in the body increases as the blood has to carry more oxygen for the survival of the fetus. The stored iron level in the body depletes, causing Iron deficiency anemia. It can also occur if the woman has been on an iron deficient diet.
Clinical symptoms of Iron deficiency anemia include:
- Fatigue
- Headache
- Restless leg syndrome
- Pica
Pregnant women are usually put on treatment consisting of iron sulfate (320 mg), ideally on only one pill a day. They are also put on a diet that is rich in meat and green leafy vegetables. However, taking more than one pill a day has shown to cause constipation.
Some of the complications of Iron deficiency anemia are:
- Preterm labor and delivery
- Perinatal mortality
- Postpartum depression
- Low birth weight of the baby
- Poor mental and psychomotor performance.
Folate and Vitamin B-12 Deficiency anemia
Deficiency of folate means that the amount of folic acid is below normal in the body. Folic acid is a type of Vitamin B-12. Folate and Viatmin B12 deficiency is far less common than Iron deficiency anemia but it also occurs due to improper diet. It can lead to neural tube defects. However, having a dose of 0.4 mg/d can decrease the risk of this deficiency.
In case the pregnant woman is detected with folate deficiency, she is put on a dose of oral folate at a dose of 1 mg, three times a day. Folate and Viatmin B12 deficiency is also known as pernicious anemia.
Not many known that certain infections can also lead to anemia, though the occurrence is extremely rare. Some of the most common causes of infectious anemia are:
- parvovirus B-19
- Cytomegalovirus (CMV)
- HIV
- Hepatitis virus
- Epstein-Barr Virus (EBV)
- Malaria
- Babesiosis
- Bartonellosis
- Clostridium toxin
These can be reversed by treating the cause.
Diamond-Blackfan anemia is an extremely rare form of anemia that can occur in only 1 out of 7 million people. It is an autosomal dominant disorder of pure red cell aplasia. People who suffer from Diamond-Blackfan anemia cannot get treated by drugs or diet; they have to be on blood transfusion for the rest of their life.
Pregnant women with Diamond-Blackfan anemia need special attention from hematologists and maternal –fetal medicine specialist. It is important that women who are pregnant maintain the required level of hemoglobin as the fetus could be at a risk of coming in contact with the iron chelating agent during transfusion.
Sickle Cell Anemia is a form of hemoglobinopathy that is genetic in nature. Sickle Cell Anemia occurs when there is a change in the structure, function and production of hemoglobin in the body. The Hemoglobin appears in the shape of a sickle, thus the name. The shape does not allow the blood cells to carry the requisite amount of oxygen in the body.
Sickle Cell Anemia occurs in various regions of the world and appears to have a pattern in certain races. It is more common in Greeks, Italians, Turks, Arabs, Southern Iranians and Asian Indians.
There is no permanent cure for Sickle Cell Anemia. In this condition, the permanently damaged red blood cells are removed from the body via the reticuloendothelial system, thus reducing the life span of the body to 17 days. However, the person may still suffer from chronic compensated anemia with hemoglobin that measure between 6.5 to 9.6 g/dL.
Complications of Sickle Cell Anemia, along with that of basic anemia include ischemic necrosis and end organ infarction. It can affect the functioning of the spleen, lungs, kidneys, heart and brain. People suffering from sickle cell anemia are at the highest risk of suffering from a dysfunction spleen or being in a state without spleen, termed as asplenic.
Treatment of Sickle cell anemia
Some of the observations that have to be made:
- They are closely observed as the condition can deteriorate fast
- Such women are put on folic acid supplements
- There should be weekly sonograms for a period of 32 gestational weeks
- Such women should be vaccinated for pneumococcal and meningococcal infections. This is because an infection with these micro-organisms can complicate the pregnancy.
- There is no need to have continuous blood transfusion as it can increase the risk of infections and alloimmunization; both of which can complicate the pregnancy.
Pregnant woman with Sickle Cell Anemia
Patients of sickle cell anemia are at a high risk of suffering from sickle cell crisis (SCC). Women who reach the stage of SCC are at a high risk of suffering from infections, thrombophlebitis and preeclampsia. They may also have a severe body ache that mainly affects abdomen, vertebrae, chest vertebrae and extremities.
However, body ache in pregnancy can also occur due to changing counts of white blood cells and lactic dehydrogenase and hence a laboratory test must be done to determine the exact cause or condition.
Thalassemia is again a genetic form of anemia that occurs due to impaired production of a normal globin peptide chain that occurs in hemoglobin. The two major types of anemia’s that occurs are known as alpha-thalassemia and beta-thalassemia. Clinically both of these can cause erythropoiesis, hemolysis and anemia. Since it is a genetic form of disease, it is important to study the medical history of maternal and paternal families.
Thalassemia is an autosomal recessive disease that occurs when there is a lethal homozygous state which occurs when the person inherits genes from both alpha and beta chains. This disease occurs all over the world but is more common in the Mediterranean region, central Africa and parts of Asia.
Women who are accepting and are suffering from thalassemia are put on blood transfusion. Along with that they are also put on ion tablets along with a diet that is rich in iron. To decrease the risk of this occurring in future, couples who have history of this disease should undergo a test. It is not necessary that they carry the same genes. They should be married to people who do not have a dominant strain. In cases people are carrying this strain and want to marry, they should consider an adoption while starting a family.
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