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Anaemia in
pregnancy (Folate
deficiency (Diagnosis (Examination
…
Anaemia in
pregnancy
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Pathophysiology
Plasma volume expansion > red cell mass
results in physiological dilution (low Hb and Hct);
no change in MCV or MCHC
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Fe deficiency
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Clinical presentation
Asymptomatic
Fatigue, malaise
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Diagnosis
Examination
Pallor, kolinychia
Investigations
Bedside: obs (might be tachycardic)
Bloods: FBC (low Hb, MCV and MCHC), Fe studies (low ferritin)
History
Malaise, fatigue,
syncope, breathlessness
Management
Oral Fe
Indication: anaemia, prophylactic for risk patients
E.g. PO ferrous sulphate
MOA: replaces stores; orange juice inc abs,
NOT with tea (dec abs)
SEs: constipation, black stools
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Folate
deficiency
Clinical presentation
Asymptomatic
Fatigue, malaise
Diagnosis
Examination
Macroglossia, angular stomatitis, pallor
Investigations
Bedside: obs (tachycardic)
Bloods: FBC (low Hb, inc MCV), folate (low)
History
Malaise, fatigue,
syncope, breathlessness
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Management
Folic acid supplementation
Indication: all women 3m pre to 12w
E.g. 400mcg/d (low risk) or 5mg/d (high risk)
MOA: replenishes folate stores,
preventing folate def anaemia and NTDs
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B12 deficiency
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Clinical presentation
Asymptomatic
Fatigue, malaise
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Diagnosis
Examination
Macroglossia, angular chelitis, pallor
Investigations
Bedside: obs (tachycardic)
Bloods: FBC (low Hb, high MCV), B12 (low)
History
Malaise, fatigue,
syncope, breathlessness
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