Anemia
• Hb concentration below 12 g/dl in a non-pregnant woman; your pregnancy
1st and III. 11 g/dl in trimesters of II. If it is below 10.5 g/dl in the third trimester, it is called anemia.
• The first of the 2 most common causes of anemia in pregnancy and puerperium is iron deficiency and the second is acute blood loss.
Causes of acquired anemia in pregnancy---------Causes of congenital anemia in pregnancy
Iron deficiency anemia--------------thalassemias
Anemia due to acute blood loss-------------Sickle cell hemoglobinopathies Anemia due to inflammation and malignancy-------------Other hemoglobinopathies Megaloblastic anemia-------- ---Hereditary hemolytic anemia
Acquired hemolytic anemia-----------------------
Aplastic or hypoplastic anemia-------------------
Iron Deficiency Anemia
► Serum ferritin level decreases physiologically during pregnancy, but 10-15 mg/L makes the diagnosis of iron deficiency anemia. A pregnant woman diagnosed with iron deficiency anemia should be given 200 mg of elemental iron daily.
Megaloblastic Anemia
► Folic acid deficiency is almost always the cause of megaloblastic anemia in pregnant women. Because the fetus and placenta absorb folic acid effectively, maternal anemia does not cause fetal anemia.
Hemolytic Anemias
► · Autoimmune Hemolytic Anemias: Hemolysis becomes significantly more pronounced during pregnancy.
► Paroxysmal Nocturnal Hemoglobinuria: Venous thrombosis is seen in approximately 40% of the cases. Pregnancy can lead to serious consequences in these patients and maternal mortality is 10-20%. Maternal complications are more common postpartum and postpartum venous thrombosis is seen in 50% of cases.
► Hemolytic Anemia Due to Bacterial Toxins: Clostridium perfringens and group A beta hemolytic streptococci cause the most severe acquired hemolytic anemia during pregnancy.
► Hereditary Spherocytosis: Generally, the course of the disease is not affected during pregnancy. Folic acid replacement is recommended for cases. The disease can lead to abortion and preterm birth.
Aplastic Anemia
► Anemia and thrombocytopenia may deepen in pregnant women with aplastic anemia. The greatest risk in these pregnant women is bleeding and infection. The risk of preterm birth, preeclampsia, IUGR and stillbirth also increases.
Hemoglobinopathies
Sickle Cell Anemia
► Pregnancy creates a significant burden for these patients; because infections and . pulmonary complications are more common. Maternal mortality rate in cases
While it is 1%, one in three fetuses may have abortion, stillbirth, IUGR and perinatal death. The risk of preeclampsia/eclampsia, ablatio placentae, preterm labor is increased.
Thalassemias: Pregnancy is well tolerated in cases of thalassemia minor.
Polycythemia Vera: Maternal thrombotic sequelae and fetal loss rate are increased. Pregnancy outcomes can improve with aspirin therapy. Women with a history of venous thrombosis should be given prophylaxis with low molecular weight heparin.
Platelet Disorders
Immune Thrombocytopenic Purpura (ITP)
► Pregnancy does not increase the risk of relapse of ITP, nor does it aggravate the clinical course in the active period. Anti-platelet autoantibodies in IgG structure can cross the placenta and cause fetal thrombocytopenia. Fetal death is also common due to the resulting hemorrhage. The risk of preterm labor also increases. Fetuses with severe thrombocytopenia are at increased risk of intracranial hemorrhage at the time of delivery. Cesarean section does not prevent fetal complications.
thrombocytosis
► The platelet count is > 450,000/ul. The most common causes of reactive thrombocytosis in pregnancy are; iron deficiency, infections, inflammatory diseases and malignancies. There is an increased risk of arterial and venous thrombosis. The risk of spontaneous abortion, fetal loss and preeclampsia increases during pregnancy.
thrombocytopenia
► Thrombocytopenia is relatively common during pregnancy and is defined as <150,000/ul platelet count. The cause of 75% is gestational thrombocytopenia, another common cause is HELLP syndrome.
Hereditary Coagulation Disorders
• The most common inherited bleeding disorder is Von Willebrand's Disease. Pregnancy outcomes are generally good; however, 50% postpartum bleeding is seen.