Anaemia in pregancy -What to observe ?

The relevance of Peripheral smear of a thin  blood slide?? How many of us scrutinize the report page of peripheral blood  smear as  soon as blood Hb is < 10 Gm at antenatal OPD ??  .Ans: Seldom we do so. But many cases the etiology  of anemia can be identified by  carefully observing the P blood smear report  and thereby may avoid detailed investigations in many cases. This is so relevant in our developing country  but many diagnois are written if we read in between lines though complete  haemogram have partially replaced many daig features of P smear. . .many are in between the line of that report. How many of us seriously enquire about added F acid , Vit B 12 suppl before coming to any Medl college with Hb of 6 Gm at 34 weeks???  How many of us seriously   examine lymphadenopathy, sternal tenderness,  hepatosplenomegaly, see tongue, nail pattern  and ask for oesophagitis  for Plummer Vinson syndrome, insist on Stool for occult blood exam . Or  say  else enquire about the cooking habits of the family , Toilet facility at fields, (hook worm)  & dietary pattern , habit tea & Coffee in particular (Iron  absorption  inhibitors)!! Seldom we enquire about Vegans/ Nonveg ?? Hope from tomorrow we will do for Indian women,

Causes of anemia::

Physiological - Pregnancy causes a state of hydraemic plethora. There is disproportionate increase of plasma volume during pregnancy leading to apparent reduction of RBC, haemoglobin and hematocrit value. Hb is consequently reduced to a varying extent occasionally as low as 80%. The dilution picture is normochromic and normocytic. This is so called physiological anaemia.

Iron deficiency anaemia (60%), Acquired- Nutritional (Microcytosis with hypopigemented central area in P smear )

Macrocytic anaemia (10%) due to deficiency of folic acid and/or vitaminB12 Acquired- Nutritionalà again P smear will speak .Dimorphic and protein deficiency anaemia (30%) both due to deficiency of iron and folic acid and /or vitaminB12

Protein deficiency -due to protein deficiency in extreme malnutrition.

Hemolytic or Haemorrhagic (due to acute blood loss,; chronic (hook worm, bleeding piles). Different kinds of cells Poikilocytoisis /Ovale cells, Tear drop cells will speak & raise a suspicion

Risk factors 1) Sociodemographic factors (age, level of formal education, marital status, areas and cities of residence).Obstetrical factors (gravidity, parity, history of previous preterm or Small-for- gestational-age deliveries, plurality of pregnancy—multiple Or singleton)

Behavioral factors (smoking or tobacco usage, alcohol usage, utilization of prenatal care services)

Medical conditions (diabetes, renal or cardio-respiratory diseases, chronic hypertension AIP—anemia in pregnancy