Book of Medical Disorders in Pregnancy - Tintash

history of asthma, hay fever or any form
of allergy. In such patients iron may
produce shock.
Reactions:
The use of intravenous iron should not
be taken lightly since in about 5 per cent
patients quite unpleasant reactions may
occur. These reactions include vomiting,
diarrhoea, and pain in the loins, pyrexia
and urticaria. Some times symptoms
such as tachycardia, flushing of face, fall
of blood pressure and syncope may
develop. Most of these reactions usually
occur during injection or within half an
hour of its completion. The student
should realize that expected rise in
hemoglobin is usually not observed until
about a week after the parenteral
administration of iron.
Placental transfer of iron:
It has been reported that some iron
dextran crosses the placenta. These
appear to have no ill effect on the fetus.
Intravenous transfusion can also cause
cardiac failure by overloading a
circulation which is already greatly
increased by hemodilution in cases of
high output cardiac failure. In such cases
where generalized edema is also present
exchange transfusion may be required.
Exchange transfusion:
In this procedure about 1,000 ml
of packed cells are run slowly into a vein
in one arm, whilst 1,500 ml of blood are
re-moved by venesection from the other
arm. We prefer to lower the circulating
blood volume by giving 40 mg of Lasix
intravenously three hours prior to the
commencement of intravenous infusion.
Protein deficiency anaemia:
10
Hemoglobin production requires
a constant supply of essential amino
acids. If women's diet is deficient in
amino acids, especially lysine and
methionine, then she can not produce
protein fraction of hemoglobin
adequately. This results in anaemia in
spite of adequate supply of iron.
Clinical features - These include
Hepato and splenomegaly, blood picture
is microcytic but normochromic, mean
corpuscular hemoglobin concentration is
normal and bone marrow biopsy shows
normoblastic reaction. These patients
also show changes in the liver biopsy
and may even proceed to cirrhosis.
Hepatic cirrhosis is considered to be
secondary to the long standing dietary
lack of lipotropic factors, which may be
accentuated by the demands of
pregnancy. This type of anaemia is
refractory to iron, folic acid, liver extract
and vitamin B12 therapy. Daily extra
supplements of high quality protein can
be very effective in such cases.
Megaloblastic anaemia: In this type of
anaemia, the bone marrow shows
megaloblastic cellular activity and
results from deficiency of folic acid in
child bearing age. The growing fetus
requires large amounts of folic acid.
Multipara gets no chance to replenish
their exhausted stores due to continued
demand posed by successive and rapid
child bearing. The folic acid deficiency
produces maturation arrest in the bone
marrow and thus interrupts the normal
course of erythropoiesis. The marrow is
filled with megaloblast, these cells can
neither carry out the functions of mature
cell nor can they be transformed to normoblast
or erythrocytes. Maturation of