Dongmei Sun1, Anne McLeod2, Shital Gandhi3, Ann Kinga Malinowski4, Nadine Shehata5. 1. Assistant Professor, Department of Medicine, Schulich School ofMedicine and Dentistry, Western University, London, Ontario, Canada. 2. Assistant Professor, Department ofMedicine, Divisions ofMedical Oncology/Hematology and ObstetricMedicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto. 3. Associate Professor, Department of Medicine, Obstetric Medicine. 4. Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology. 5. Associate Professor, Departments of Medicine and Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Abstract
IMPORTANCE: Anemia is common in pregnancy, ranging from 5.4% in developed countries to more than 80% in developing countries. Anemia in pregnancy has been associated with prematurity, low birth weight, and adverse pregnancy outcomes. OBJECTIVE: This review uses clinical vignettes to illustrate the clinical presentations, approach to diagnosis, maternal and fetal implications, and treatment for the common etiologies of anemia in pregnancy. EVIDENCE ACQUISITION: Literature review. RESULTS: Normal physiological changes in pregnancy result in alterations of hematological parameters particularly in a reduction of hemoglobin (Hb) concentration. Consequently, the Hb used to define anemia in pregnancy is lower than in nonpregnant patients. As there is an increased requirement of iron in pregnancy, it is not unexpected that iron deficiency remains the most common cause of anemia and warrants a preemptive approach to prevent a further reduction in Hb. The syndromes associated with microangiopathic hemolytic anemia may pose a diagnostic challenge, as there are several potential etiologies that may be difficult to differentiate, and microangiopathic hemolytic anemia can be associated with significant maternal and fetal morbidity andmortality. Anemia secondary to sickle cell disease and autoimmune hemolytic anemiamerit special attention because there are risks secondary to red blood cell transfusion and risks to withholding transfusion. CONCLUSIONS: Anemia in pregnancy is potentially associated with maternal and fetal adverse outcomes. Providing evidence-based care is essential to achieving the best pregnancy outcomes.
IMPORTANCE: Anemia is common in pregnancy, ranging from 5.4% in developed countries to more than 80% in developing countries. Anemia in pregnancy has been associated with prematurity, low birth weight, and adverse pregnancy outcomes. OBJECTIVE: This review uses clinical vignettes to illustrate the clinical presentations, approach to diagnosis, maternal and fetal implications, and treatment for the common etiologies of anemia in pregnancy. EVIDENCE ACQUISITION: Literature review. RESULTS: Normal physiological changes in pregnancy result in alterations of hematological parameters particularly in a reduction of hemoglobin (Hb) concentration. Consequently, the Hb used to define anemia in pregnancy is lower than in nonpregnant patients. As there is an increased requirement of iron in pregnancy, it is not unexpected that iron deficiency remains the most common cause of anemia and warrants a preemptive approach to prevent a further reduction in Hb. The syndromes associated with microangiopathic hemolytic anemia may pose a diagnostic challenge, as there are several potential etiologies that may be difficult to differentiate, and microangiopathic hemolytic anemia can be associated with significant maternal and fetal morbidity andmortality. Anemia secondary to sickle cell disease and autoimmune hemolytic anemiamerit special attention because there are risks secondary to red blood cell transfusion and risks to withholding transfusion. CONCLUSIONS: Anemia in pregnancy is potentially associated with maternal and fetal adverse outcomes. Providing evidence-based care is essential to achieving the best pregnancy outcomes.
Authors: Felix Bongomin; Ronald Olum; Andrew Peter Kyazze; Sandra Ninsiima; Gloria Nattabi; Lourita Nakyagaba; Winnie Nabakka; Rebecca Kukunda; Phillip Ssekamatte; Davis Kibirige; Stephen Cose; Annettee Nakimuli; Joseph Baruch Baluku; Irene Andia-Biraro Journal: Trop Med Health Date: 2021-03-01
Authors: Iain C Macdougall; Josep Comin-Colet; Christian Breymann; Donat R Spahn; Ioannis E Koutroubakis Journal: Adv Ther Date: 2020-04-15 Impact factor: 3.845