Anemia with pregnancy

Anemia in pregnancyAnemia in pregnancy

bybyIslam abdel-baset hashimIslam abdel-baset hashim

Islam abdel-fattahIslam abdel-fattah kalilkalil

Islam abd allah mohammadIslam abd allah mohammad

Anemia in pregnancyAnemia in pregnancy

bybyIslam abdel-baset hashimIslam abdel-baset hashim

Islam abdel-fattahIslam abdel-fattah kalilkalil

Islam abd allah mohammadIslam abd allah mohammad

DefinitionDefinition

Anemia - insufficient Hb to carry out O2 requirement

by tissues.

WHO definition : Hb conc. 11 gm %

CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester

For developing countries : cut off level suggested is 10 gm %

-

Anemia - insufficient Hb to carry out O2 requirement

by tissues.

WHO definition : Hb conc. 11 gm %

CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester

For developing countries : cut off level suggested is 10 gm %

-

Degree Hb% Haematocrit (%)

Moderate 7-10.9 24-37%

Severe 4-6.9 13-23%

Very Severe <4 <13%

Degree Hb% Haematocrit (%)

Moderate 7-10.9 24-37%

Severe 4-6.9 13-23%

Very Severe <4 <13%

WHO Classification of Anaemia WHO Classification of Anaemia

Magnitude of ProblemMagnitude of ProblemMagnitude of ProblemMagnitude of Problem

Globally, is about 30 %Globally, is about 30 %

In developing countries & In developing countries & India, incidence is around India, incidence is around 40 – 90%.40 – 90%.

Responsible for 40% of Responsible for 40% of maternal deaths in third world maternal deaths in third world countries.countries.

Important cause of direct and Important cause of direct and indirect maternal deathsindirect maternal deaths

Globally, is about 30 %Globally, is about 30 %

In developing countries & In developing countries & India, incidence is around India, incidence is around 40 – 90%.40 – 90%.

Responsible for 40% of Responsible for 40% of maternal deaths in third world maternal deaths in third world countries.countries.

Important cause of direct and Important cause of direct and indirect maternal deathsindirect maternal deaths

physiological changes in physiological changes in pregnancy pregnancy

Plasama volume increased by 50% (by 34weeks)Plasama volume increased by 50% (by 34weeks)

But RBC mass only increased by 25% But RBC mass only increased by 25%

Results in haemodilution :Results in haemodilution :

No change in MCV or MCHNo change in MCV or MCH

2-3 fold increase in Fe requierment.2-3 fold increase in Fe requierment.

10-20 Fold increase in folate requirement10-20 Fold increase in folate requirement

Common Anaemias in Common Anaemias in pregnancypregnancy

Nutritional deficiency anaemiasNutritional deficiency anaemias

- Iron deficiency - Iron deficiency

- Folate deficiency- Folate deficiency

- Vit. B12 deficiency - Vit. B12 deficiency

Haemoglobinopathies: Haemoglobinopathies:

- Thallassemias- Thallassemias

- SCD- SCD

  ETIOLOGY OF IRON ETIOLOGY OF IRON

DEFICIENCY ANAEMIADEFICIENCY ANAEMIA Depleted iron storesDepleted iron stores– dietary lack, chronic – dietary lack, chronic

renal failure, worm infestation, chronic menorrhagiarenal failure, worm infestation, chronic menorrhagia

Chronic infectionsChronic infections: ( like malaria) : ( like malaria)

Repeated pregnanciesRepeated pregnancies : :

with interval < 1 year with interval < 1 year

blood loss at time of deliveryblood loss at time of delivery

multiple pregnancymultiple pregnancy

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Poor pre-pregnancy iron balance due to – Poor pre-pregnancy iron balance due to – untreated systemic diseases & menstrual disorders untreated systemic diseases & menstrual disorders

Improper supplementation of iron in pregnancy ( late Improper supplementation of iron in pregnancy ( late registration and poor follow up)registration and poor follow up)

Repeated childbearingRepeated childbearing

Lack of awareness and illiteracyLack of awareness and illiteracy

Absorption of Ferrous SaltsAbsorption of Ferrous Salts

Iron RequirementIron Requirement

Iron Absorption Iron Absorption 11 Amount of iron in the

body Amount of iron in the

body

Iron Loss

Skin

Urine

Feces

Menstruation

1-2mg/d1-2mg/d

20-30mg/c20-30mg/c

Early Pregnancy

2.5 mg / day

32 to 40 weeks

6.8 mg / day

TOTAL800 – 1000

mg

20 to 32 weeks

5.5 mg / day

RBC =500mgFetus+Placenta =450mgThird stage blood loss=200mgTotal = 1150mg

Iron Requirement During PregnancyIron Requirement During Pregnancy

Infection

Lack of Concentration

Weakness

Irritability

Palpitation

Fatigue

Dizziness

SymptomsSymptoms

Clinical FeaturesClinical FeaturesClinical FeaturesClinical Features

Pallor of skin And m/m

Edema

PlatynychiaKoilonychia PlatynychiaKoilonychia

Glossitis

Stomatitis

Tachycardi

a

Soft ejectionsystolic murmur

SignsSigns

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Poor pre-pregnancy iron balance due to – Poor pre-pregnancy iron balance due to – untreated systemic diseases & menstrual untreated systemic diseases & menstrual disorders disorders

Improper supplementation of iron in pregnancy Improper supplementation of iron in pregnancy ( late registration and poor follow up)( late registration and poor follow up)

Repeated childbearingRepeated childbearing

Lack of awareness and illiteracyLack of awareness and illiteracy

Poor pre-pregnancy iron balance due to – Poor pre-pregnancy iron balance due to – untreated systemic diseases & menstrual untreated systemic diseases & menstrual disorders disorders

Improper supplementation of iron in pregnancy Improper supplementation of iron in pregnancy ( late registration and poor follow up)( late registration and poor follow up)

Repeated childbearingRepeated childbearing

Lack of awareness and illiteracyLack of awareness and illiteracy

Low socioeconomic status and poor hygieneLow socioeconomic status and poor hygiene

Chronic malnutritionChronic malnutrition

Poor availability of iron due to predominantly Poor availability of iron due to predominantly veg diet, diet low in calories but rich in phytates. veg diet, diet low in calories but rich in phytates. Food and religious taboosFood and religious taboos

GI infections and infestations GI infections and infestations (e.g. Kala azar, worm infestations)(e.g. Kala azar, worm infestations)

Low socioeconomic status and poor hygieneLow socioeconomic status and poor hygiene

Chronic malnutritionChronic malnutrition

Poor availability of iron due to predominantly Poor availability of iron due to predominantly veg diet, diet low in calories but rich in phytates. veg diet, diet low in calories but rich in phytates. Food and religious taboosFood and religious taboos

GI infections and infestations GI infections and infestations (e.g. Kala azar, worm infestations)(e.g. Kala azar, worm infestations)

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

EFFECTS OF ANAEMA IN EFFECTS OF ANAEMA IN PREGNANCYPREGNANCY

Mother :Mother :

High output Cardiac failure (more likely if High output Cardiac failure (more likely if precelampsia present. inadequate tissue precelampsia present. inadequate tissue oxygenation increase requirments for excessive oxygenation increase requirments for excessive blood flow )blood flow )

PPH PPH

Predisposes to infectionPredisposes to infection

Risk of thrombo-embolism Risk of thrombo-embolism

Delayed general physical recovery esp after c. Delayed general physical recovery esp after c. sectionsection

Fetus: . IUGRFetus: . IUGR

. Preterm birth. Preterm birth

. LBW. LBW

. Depleted Fe store . Depleted Fe store

. Delayed Cognitive function.. Delayed Cognitive function.

IUGR

IUD IUH

CCFCCF

INFECTIONINFECTION

PRETERM LABOUR

PRETERM LABOUR

PIHPIH

Medical DisorderMedical Disorder

Complications - PregnancyComplications - PregnancyComplications - PregnancyComplications - Pregnancy

Instrumental delivery

PPH

FoetalDistressCCF

MATERNALPERINATAL

MorbidityMortality

Complications - LabourComplications - LabourComplications - LabourComplications - Labour

INVESTIGATIONSINVESTIGATIONS

HbdecreasedHbdecreased

Haematocrit decreasedHaematocrit decreased

RBC Indices:RBC Indices:

- Low MCV - Low MCV

- Low MCH- Low MCH

- Low MCHC- Low MCHC

- Low PCV- Low PCV

Peripheral blood picture :Peripheral blood picture :

MicrocyticHypochromicanaemia .MicrocyticHypochromicanaemia .

Serum iron decreased (<12 micro mol / l) Serum iron decreased (<12 micro mol / l) 

Total iron binding capacity:Total iron binding capacity:

TIBC in non-pregnant state is 33% saturated with TIBC in non-pregnant state is 33% saturated with iron .when serum iron level fall ,<15% ofTIBC iron .when serum iron level fall ,<15% ofTIBC saturated.by fall in saturation,the TIBC INCREASED.saturated.by fall in saturation,the TIBC INCREASED.

S. ferritin :In healthy adults ferritin circulate in S. ferritin :In healthy adults ferritin circulate in plasma in range of 15_300 pg/l. in iron deficiency plasma in range of 15_300 pg/l. in iron deficiency anemia it is the first test to become abnormal. anemia it is the first test to become abnormal. 

Serum transferrinreceptor(TfR)Serum transferrinreceptor(TfR)

present on all cells as transmembrane protien that present on all cells as transmembrane protien that binds transferrin iron and transfer it to cell interior. binds transferrin iron and transfer it to cell interior. Increased in iron def. anemiaIncreased in iron def. anemia

Bone marrow examination.Bone marrow examination.

Urine for haemturia.Urine for haemturia.

Stool examination for ova ,cyst and occult blood.Stool examination for ova ,cyst and occult blood.

Management Options Management Options Management Options Management Options

Pre – pregnancy :

Treat the cause before conception

Pre-pregnancy balanced diet, education

and health support.

Build up iron stores during adolescent

phase

Pre – pregnancy :

Treat the cause before conception

Pre-pregnancy balanced diet, education

and health support.

Build up iron stores during adolescent

phase

Oral Iron

Blood transfusionParenteral

Injectable IronInjectable IronHuman Recombinant

Erythropoietin

Modalities of ManagementModalities of ManagementModalities of ManagementModalities of Management

elemental Iron -------120 –240mg / per dayelemental Iron -------120 –240mg / per day

Iron stores poor

-ve-ve

Iron absorption

↓ Bioavailability

of Iron

-ve-ve-ve-ve

Phosphate phytate

Worm infestation

Oral IronOral IronOral IronOral Iron

↑ Hb – 0.21 gm %

Fractionated Irondextran[Iron hydroxide dextran

complex]

Les s

Les s

Les

s Les

s

Parenteral TherapyParenteral Therapy

120 mg elemental Iron

Anaphylactic Anaphylactic reactionreaction

Anaphylactic Anaphylactic reactionreaction

I.M. I.V.

Parenteral Therapy : Parenteral Therapy : Traditional IndicationsTraditional IndicationsParenteral Therapy : Parenteral Therapy :

Traditional IndicationsTraditional Indications

Intolerance to oral iron Intolerance to oral iron

Poor compliance to oral iron Poor compliance to oral iron

Gastrointestinal disorders Gastrointestinal disorders

Malabsorption syndromesMalabsorption syndromes

Rapid blood loss Rapid blood loss

Intolerance to oral iron Intolerance to oral iron

Poor compliance to oral iron Poor compliance to oral iron

Gastrointestinal disorders Gastrointestinal disorders

Malabsorption syndromesMalabsorption syndromes

Rapid blood loss Rapid blood loss

Inability to maintain iron balance Inability to maintain iron balance (haemodialysis)(haemodialysis)

Patient donating large amount of blood Patient donating large amount of blood for auto-transfusion programmefor auto-transfusion programme

? Pregnant women with severe IDA, ? Pregnant women with severe IDA, presenting late in pregnancypresenting late in pregnancy

Inability to maintain iron balance Inability to maintain iron balance (haemodialysis)(haemodialysis)

Patient donating large amount of blood Patient donating large amount of blood for auto-transfusion programmefor auto-transfusion programme

? Pregnant women with severe IDA, ? Pregnant women with severe IDA, presenting late in pregnancypresenting late in pregnancy

Parenteral Therapy : Parenteral Therapy : Indications Indications

Parenteral Therapy : Parenteral Therapy : Indications Indications

TheThe

World Health OrganisationWorld Health Organisation states…states…

‘‘transfusion should be transfusion should be

prescribed prescribed ONLYONLY for for

conditions for which there conditions for which there

is is NONO OTHER TREATMENT’ OTHER TREATMENT’

Side effect of Fe Oral therapySide effect of Fe Oral therapy

. G. I upset.. G. I upset.

. Constipation.. Constipation.

. Diarrhoea.. Diarrhoea.

Side effect of Parentral ironSide effect of Parentral iron

- skindiscolouration- skindiscolouration

- local abscess- local abscess

- allergic reaction- allergic reaction

- Fe over load- Fe over load

Reasons for Failure to Reasons for Failure to RespondRespond

Non complianceNon compliance

Concomitant folate deficiencyConcomitant folate deficiency

Continuous loss of blood through hookworm Continuous loss of blood through hookworm infestation or bleeding haemorrhoidsinfestation or bleeding haemorrhoids

Co-existing infectionCo-existing infection

Faulty iron absorptionFaulty iron absorption

Inaccurate diagnosisInaccurate diagnosis

Non iron deficiency microcytic anaemiaNon iron deficiency microcytic anaemia

MEGALOBLASTIC ANAEMIAMEGALOBLASTIC ANAEMIA

Complicates upto 1% of pregnanciesComplicates upto 1% of pregnancies

Characterized by :Characterized by :

- RBC with high MCV- RBC with high MCV

- White blood cells with altered morphology- White blood cells with altered morphology

(hypersegmented neutrophils(hypersegmented neutrophils

causescauses

Folate deficiency :may occur after exposureFolate deficiency :may occur after exposure

to sulfa drugs or hydroxyureato sulfa drugs or hydroxyurea

- Vitamin B12 deficiency - Vitamin B12 deficiency

Folic acid deficiencyFolic acid deficiency

At cellular levelAt cellular level

Folic acid reduced to Dihydrofolicacid thenFolic acid reduced to Dihydrofolicacid then

Tetrahydro-folicacid . (THF) Tetrahydro-folicacid . (THF) ee is required for cell is required for cell growth & division. growth & division.

dependant on supply of folic acid.dependant on supply of folic acid.

So bone marrow and epithelial lining are therefore at So bone marrow and epithelial lining are therefore at particular risk.particular risk.

causescauses

. Woman taking anticonvulsants.. Woman taking anticonvulsants.

. Multiple pregnancy.. Multiple pregnancy.

. Hemolytic anemia; thalasemiaH.spherocytosis. Hemolytic anemia; thalasemiaH.spherocytosis

investigationinvestigationinvestigationinvestigation

Macrocytes on Macrocytes on peripheral smearperipheral smear

Hypersegmentation of Hypersegmentation of neutrophilsneutrophils

PancytopeniaPancytopenia

Low Hb and high MCVLow Hb and high MCV

Megablastosis on bone Megablastosis on bone marrowmarrow

Serum folate <3ng/ mlSerum folate <3ng/ ml

Macrocytes on Macrocytes on peripheral smearperipheral smear

Hypersegmentation of Hypersegmentation of neutrophilsneutrophils

PancytopeniaPancytopenia

Low Hb and high MCVLow Hb and high MCV

Megablastosis on bone Megablastosis on bone marrowmarrow

Serum folate <3ng/ mlSerum folate <3ng/ ml

treatmenttreatment

Daily folate requirement for :Daily folate requirement for :

Non pregnant women -- 50 -100 microgram Non pregnant women -- 50 -100 microgram

Pregnant woman –-------- 300-400 microgram Pregnant woman –-------- 300-400 microgram

Usually folic acid present in diets like fresh fruits Usually folic acid present in diets like fresh fruits and vegetables and destroyed by cooking.and vegetables and destroyed by cooking.

Folic acidFolic acid - 0.5-1.0mg folic acid/day - 0.5-1.0mg folic acid/day

Ifpresence .of neural tube defect - 4mg folic Ifpresence .of neural tube defect - 4mg folic acid/day.acid/day.

HemoglobinopathiesHemoglobinopathies

Inherited disorders of haemoglobin.Inherited disorders of haemoglobin.

Defect may be in:Defect may be in:

Globin chain synthesis------Globin chain synthesis------thalassemia”quantitative defect”thalassemia”quantitative defect”

Structure of globin chains-sickle cell Structure of globin chains-sickle cell disease”qualitdisease”qualit

Hb.abnormalities may be:Hb.abnormalities may be:

Homozygous(rr) = inherited from both parents. Homozygous(rr) = inherited from both parents. Hetrozygous(Rr) = inherited from one parentHetrozygous(Rr) = inherited from one parent

Inherited disorders of haemoglobin.Inherited disorders of haemoglobin.

Defect may be in:Defect may be in:

Globin chain synthesis------Globin chain synthesis------thalassemia”quantitative defect”thalassemia”quantitative defect”

Structure of globin chains-sickle cell Structure of globin chains-sickle cell disease”qualitdisease”qualit

Hb.abnormalities may be:Hb.abnormalities may be:

Homozygous(rr) = inherited from both parents. Homozygous(rr) = inherited from both parents. Hetrozygous(Rr) = inherited from one parentHetrozygous(Rr) = inherited from one parent

HAEMOGLOBINOPATHIES.HAEMOGLOBINOPATHIES.

Normal adult Hb. after age of 6 month,Normal adult Hb. after age of 6 month,

HbA---97%, HbA2---(1.5-3.5%), HbF2--<1%.HbA---97%, HbA2---(1.5-3.5%), HbF2--<1%.

4 Globin chains associated with haem complex.4 Globin chains associated with haem complex.

Hb. A = 2 alpha +2 beta globin chains.Hb. A = 2 alpha +2 beta globin chains.

Hb.A2= 2alpha+2 delta globin chains.Hb.A2= 2alpha+2 delta globin chains.

Hb.F = 2 alpha+ 2 gamma globin chains.Hb.F = 2 alpha+ 2 gamma globin chains.

Hb. synthesis is controlled by genes.Hb. synthesis is controlled by genes.

Alpha chains by 4 gene,2 from each parent.Alpha chains by 4 gene,2 from each parent.

Beta chains by 2 genes ,1 from each parent.Beta chains by 2 genes ,1 from each parent.

ThalassemiaThalassemia

The synthesis of globin chain is partially or The synthesis of globin chain is partially or completely suppressed resulting in reduced Hb. completely suppressed resulting in reduced Hb. content in red cells,which then have shortened life content in red cells,which then have shortened life spanspan

TYPES:TYPES:

a- Alpha thalassaemia.a- Alpha thalassaemia.

b- Beta thalassaemia: b- Beta thalassaemia:

. Major. Major

. minor. minor

The synthesis of globin chain is partially or The synthesis of globin chain is partially or completely suppressed resulting in reduced Hb. completely suppressed resulting in reduced Hb. content in red cells,which then have shortened life content in red cells,which then have shortened life spanspan

TYPES:TYPES:

a- Alpha thalassaemia.a- Alpha thalassaemia.

b- Beta thalassaemia: b- Beta thalassaemia:

. Major. Major

. minor. minor

ThalassemiaThalassemia

Genetic disorders; lack or Genetic disorders; lack or sed synthesis of globin sed synthesis of globin chainschains

Two types : Two types : & & thalassemia thalassemia

chains encoded by 2 pairs of genes on chains encoded by 2 pairs of genes on chromosome 16chromosome 16

chains encoded by single pair of genes on chains encoded by single pair of genes on chromosome 11chromosome 11

thalassemia more common and presents as eitherthalassemia more common and presents as either °(major) or °(major) or ++ (minor) (minor)

Genetic disorders; lack or Genetic disorders; lack or sed synthesis of globin sed synthesis of globin chainschains

Two types : Two types : & & thalassemia thalassemia

chains encoded by 2 pairs of genes on chains encoded by 2 pairs of genes on chromosome 16chromosome 16

chains encoded by single pair of genes on chains encoded by single pair of genes on chromosome 11chromosome 11

thalassemia more common and presents as eitherthalassemia more common and presents as either °(major) or °(major) or ++ (minor) (minor)

Beta thalassemia minorBeta thalassemia minor

Heterozygous inheritance from one parent.Heterozygous inheritance from one parent.

Most frequent encountered variety.Most frequent encountered variety.

Partial suppression of the Hb. synthesis.Partial suppression of the Hb. synthesis.

Mild anaemia.Mild anaemia.

IInvestigationsnvestigations: Hb----around 10 g/dl.: Hb----around 10 g/dl.

Red cell indices: low MCV.Red cell indices: low MCV.

low MCH.low MCH.

normal MCHC.normal MCHC.

Diagnostic testDiagnostic test: Hb. Electrophoresis.: Hb. Electrophoresis.

Beta Thalassemia MinorBeta Thalassemia Minor

Management:Management:

Same as normal woman in pregnancy.Same as normal woman in pregnancy.

Frequent Hb. Testing.Frequent Hb. Testing.

Iron & folate supplements in usual dose.Iron & folate supplements in usual dose.

Parenteral iron should be avoided. because of iron overload.Parenteral iron should be avoided. because of iron overload.

If not responded ---I/M folic acid.If not responded ---I/M folic acid.

blood transfusion close to time of delivery.blood transfusion close to time of delivery.

Beta Thalassaemia MajorBeta Thalassaemia Major

Homozygous inheritance from both parents.Homozygous inheritance from both parents.

Sever anaemia.Sever anaemia.

ALPHA THALASSAEMIA:ALPHA THALASSAEMIA:

Both heterozygous & homozygous forms exist.Both heterozygous & homozygous forms exist.

Alpha thalassaemia trait.Alpha thalassaemia trait.

HbH disease.HbH disease.

Alpha thalassaemia major.Alpha thalassaemia major.

Diagnosis of ThalassemiaDiagnosis of Thalassemia

Hb----around 10 g/dl.Hb----around 10 g/dl.

Red cell indices: low MCV.Red cell indices: low MCV.

–low MCH.low MCH.

–normal MCHC.normal MCHC.

Diagnostic testDiagnostic test: Hb. : Hb. Electrophoresis.Electrophoresis.

Hb----around 10 g/dl.Hb----around 10 g/dl.

Red cell indices: low MCV.Red cell indices: low MCV.

–low MCH.low MCH.

–normal MCHC.normal MCHC.

Diagnostic testDiagnostic test: Hb. : Hb. Electrophoresis.Electrophoresis.

Sickle Cell Disease (SCD)Sickle Cell Disease (SCD)

Sickeling crises frequently occurs in pregnancy, puerperium &in Sickeling crises frequently occurs in pregnancy, puerperium &in state of hypoxia like G/A and Hag.state of hypoxia like G/A and Hag.

Increased incidance of abortion and still birthIncreased incidance of abortion and still birth

growth restriction, premature birth and intrapartum fetal distress growth restriction, premature birth and intrapartum fetal distress with increased perinatal mortality.with increased perinatal mortality.

Sickle cell trait:(carrier state)Sickle cell trait:(carrier state)

Does not pose any significance clinical problemsDoes not pose any significance clinical problems

Sickle Cell DiseaseSickle Cell Disease

Autosomally inherited .Autosomally inherited .

Structural abnormality.Structural abnormality.

HbS - susceptible to hypoxia, when HbS - susceptible to hypoxia, when oxygen supply is reduced. oxygen supply is reduced.

Hb precipitates & makes the RBCs Hb precipitates & makes the RBCs rigid & sickle shaped.rigid & sickle shaped.

May be:May be:

Heterozygous----HbAS.Heterozygous----HbAS.

Homozygous-----HbSS.Homozygous-----HbSS.

Autosomally inherited .Autosomally inherited .

Structural abnormality.Structural abnormality.

HbS - susceptible to hypoxia, when HbS - susceptible to hypoxia, when oxygen supply is reduced. oxygen supply is reduced.

Hb precipitates & makes the RBCs Hb precipitates & makes the RBCs rigid & sickle shaped.rigid & sickle shaped.

May be:May be:

Heterozygous----HbAS.Heterozygous----HbAS.

Homozygous-----HbSS.Homozygous-----HbSS.

Diagnosis: Diagnosis:

- Hb. Electrophoesis - Hb. Electrophoesis

Sickle test is screening test Sickle test is screening test

Management: Management:

- No curative Tx. - No curative Tx.

- only symptomatic- only symptomatic

- Well hydration, effective analgesia, prophylactic - Well hydration, effective analgesia, prophylactic

antibiotics, O2 inhalation, folic acid, oral ironantibiotics, O2 inhalation, folic acid, oral iron

supplement (I/V iron is C/I), blood transfusion supplement (I/V iron is C/I), blood transfusion

Management During labourManagement During labour

Comfortable PositionComfortable Position

Adequate analgesiaAdequate analgesia

O2 inhalationO2 inhalation

Low threshold of assisted deliveryLow threshold of assisted delivery

Prophylactic antibioticsProphylactic antibiotics

Continue iron &folate therapy for 3 mo after deliveryContinue iron &folate therapy for 3 mo after delivery

Thank YouThank You

Egypt