Introduction

Anemia is a hematologic disorder that occurs when there is not enough iron in the blood. Iron is an important building block for hemoglobin, the part of red blood cells that carries oxygen. If red blood cells are deficient in hemoglobin, then your body isn't getting enough oxygen. Anemia in pregnancy is very common and is present in almost 8o% of pregnant women. Because volume of blood increases during pregnancy (hemodilution), a moderate decrease in the concentration of red blood cells and hemoglobin is normal. However because of hemodilution, the hematocrit value (the percentage of red blood cells relative to plasma volume) of pregnant women become much lower than the normal value which is 38-45%. This lower range simply reflects "the physiologic hemodilution of pregnancy" and does not indicate a decrease in oxygen carrying capacity or true anemia. During pregnancy, the amount of blood in the body must increase by almost 50% to feed the growing baby. As a result, the mothers body starts to make blood at a faster pace. Sometimes the need for iron is greater than the amount stored in the body. The result is iron deficiency anemia.

Iron deficiency Anemia

Iron-deficiency anemia is the most common anemia of pregnancy, complicating as many as 15-20% of all pregnancies (Malee, 2003). Many women enter pregnancy with a deficiency of iron stores resulting from a diet low in iron, heavy menstrual periods, loss of blood from bleeding hemorrhoids or gastrointestinal bleeding. or unwise weight reducing program. Even if iron and folic acid intake are sufficient, a pregnant woman may become anemic because

pregnancy alters the digestive process. Iron stores are also apt to be low in women who were pregnant less than 2 years before the current pregnancy or those from low socio-economic levels who have not had iron-rich diets.

Clinical Manifestations
Anemia often occurs at the beginning of the second trimester and can mask as simply "pregnancy fatigue." Symptoms of anemia like fatigue occur because organs aren't getting what they need to function properly. Because the body recognizes that it needs increased nutrients, some women develop pica, or the craving and eating of substances such as ice, starch or charcoal. She can also experience poor exercise tolerance because she cannot transport oxygen effectively. Other occasional clinical manifestations of anemia are; headache, nausea, splenomegaly, inflamed, sore tongue and palpitations or abnormal awareness of the heartbeat.

Pathophysiology
Iron is made available to the body by absorption from the duodenum into the bloodstream after it is ingested. In the bloodstream, it is bound to transferrin for transport to the liver, spleen and bone marrow. At these sites it is incorporated into hemoglobin or stored as ferritin. In pregnancy, iron deficiency anemia is characteristically a microcytic (small red blood cell), hypochromic (less hemoglobin than average red cell) anemia. It is because when an inadequate supply of iron is ingested, iron is unavailable for incorporation into red blood cells. Both hematocrit and hemoglobin will be reduced (under 33% and 12mg/dL respectively). The serum transferrin will be under 5%, the serum iron level will be under 30g/dL, and the mean

corpuscular hemoglobin concentration will be under 30; iron binding capacity in contrast will be increased (over 400 g/dL). For example, chronic blood loss from excessive menstrual bleeding. each milliliter of blood contains 0.5mg of iron. Loss of 500 milliliters of blood creates a loss of 250 milliliters of iron, the equicalent of 25% of the bodys iron reserves. . Blood loss of 10-20 milliliters of red cells per day is greater than the amount of iron a person can absorb in the diet. Iron deficiency anmei is mildly associated with low birth weight and pre-term birth.

Diagnosis Examination
The diagnosis is based on blood tests which determine the red blood cell count, hemoglobin level ,iron and folic acid levels in the blood. Hematocrit levels less than 33% and hemoglobin level is below 12mg/dL, iron deficiency is suspected. It is confirmed by a corresponding low serum iron level and an increased iron-binding capacity. Because anemia is so common, doctors and midwives usually check the blood for anemia during the first prenatal visit. Sometimes they will repeat the test at about 28 weeks of pregnancy, or whenever there is a concern that the woman may be anemic.

Treatment
To prevent this common anemia, women should take prenatal vitamins containing an iron supplement of 60 mg elemental iron as prophylactic therapy during pregnancy. In addition, they need to eat a diet high in iron and vitamins (green leafy vegetables, meat, legumes, fruits). Women who developed iron deficiency anemia will be prescribed therapeutic levels of medication (120 to 180 mg elemental iron/day), usually in the form of ferrous sulfate or ferrous gluconate. Iron is best absorbed in the form of an acid medium.

Nursing Management and Interventions

Advised the mother to take iron supplements with orange juice or a vitamin C supplement. Avoid giving iron with milk because the calcium prevents it from being used by the mothers body. Sometimes the iron tablets can make the mothers bowel movements darkcolored or even black. This color is from extra iron that was not absorbed in her body. It is not dangerous. Some women report constipation or gastris irritation when taking oral iron supplement. Increasing roughage in the diet and always taking the pills with food helps reduce these symptoms. When women begin to take a prescribed iron supplement, new red blood cells should begin to increased by two weeks.

University of Makati J.P. Rizal, West Rembo, Makati

Pregnancy with Anemia

Submitted by: Fatima G. Dalida 2BN2

Submitted to: Mrs. Jennifer Domingo