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Anemia in Pregnancy
Nutritional iron deficiency is the most common cause of anemia in pregnancy. Diagnosis is commonly based on hemogram with peripheral smear examination showing microcytic hypochromic picture. Presence of macrocytes, hypersegmented neutrophils suggests additional folate deficiency(nutritional dimorphic anemia). Treatment can be started after initial peripheral smear examination and response assessed by increase in reticulocyte count in 1 week and hemoglobin rise in 2-3 weeks. If no response consider thalassemia. Blood transfusion is required in cardiac failure,severe anemia with Hb < 5gm%,non responding /non nutritional anemia or later pregnancy with the aim to increase Hb levels to at least 8gm% before delivery. Normal values during pregnancy are MCH 26-31pg MCV 75-95 fl, MCHC 30-35% Serum iron 65-75microgm/100ml TIBC 300-400microgm/100ml Serum ferritin > 15microgm/L.
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