Book of Medical Disorders in Pregnancy - Tintash

normal in four to six weeks after
delivery.
Epidemiology:
Body of a healthy adult woman contains
3,500-4,500mg iron of which 75% is in
red blood cells as hemoglobin, 20% as
ferritin in bone marrow and reticuloendothelial
system and 5% in muscles
and enzyme systems. Nearly all of iron
in red blood cells is recycled as they are
replaced every 100-120 days. Normal
loss is 1mg iron from death of epithelial
cells plus an average of 1mg daily from
monthly menstrual loss. Average
woman’s diet in developed world
provides 12mg iron daily, of which 14-
20% is absorbed so a balance is
maintained.
However, in developing countries with a
mainly vegetarian diet iron levels are
low because of the relative lack of iron
in the diet and the ability of phytate in
cereals to interfere with iron absorption.
Also, in many countries, very high level
of infestation with hookworm, which
causes considerable fecal blood loss?
Presence of occult blood in coeliac
disease in pregnancy has a strong association
with anaemia.
The bone marrow aspirate shows normoblastic
reaction with a slight increase
in the number of plasma cells and
megakaryocytes.
Clinical features:
Features which are common to all
anemias of pregnancy include tiredness,
listlessness, headache and bouts of
giddiness. There may also be anorexia
and indigestion, due to hypochlorhydria
which develops sec-ondary to nutritional
deficiency states. Cardiac output is
increased and systolic ejection murmur
can be heard over the base of the heart.
A third heart sound can sometimes be
heard at the apex in these cases. This
sound is due to rapid diastolic filling of
the left ventricle. In patients with
organic heart disease, there may be signs
of cardiac failure. Ectopic beats are a
frequent phenomenon which is often
noted as palpitations. Slight edema of
the ankles may be present, when severe
anemia with megaloblastic picture is
present. This may sometimes be accompanied
by hypertension and mild
albuminuria, which disappears when the
anemia is corrected. Incidence of
premature labor is more in these cases. If
anemia is severe, fetal anoxia may result
in intrauterine death of the fetus.
Iron deficiency Anaemia
Anaemia Normal Blood
Fig 1.1: Shows hypochromic anaemic
red cells in the left picture and normal
red cells in the right picture
It has been reported that uterine inertia
may be increased and labor prolonged,
but the reason for this is not known.
Incidence of puerperal infection and
venous thrombosis is increased.
Common symptoms:
Mild Anaemia:
Decreases capacity to do physical and
mental work. Reduces concentration,
attention and, memory affecting school
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