Anemia powerpoint presentation

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					ANAEMIA: Preventable,
   Yet a Problem!!
                            Definition
   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 %
     - WHO technical report Series no. 405, Geneva 1968
      Centre for disease control, MMWR 1989;38:400-4
     WHO Classification of Anaemia

Degree        Hb%      Haematocrit (%)



Moderate      7-10.9     24-37%

Severe        4-6.9      13-23%

Very Severe     <4         <13%
                            Magnitude of Problem

    Globally, is about 30 %
    In developing countries &
     India, incidence is around
     40 – 90%.
    Responsible for 40% of
     maternal deaths in third world
     countries.
    Important cause of direct and
     indirect maternal deaths
    - Vitere FE Adv Exp Med Biol 1994;352:127
 Symptoms
                        Irritability
    Lack of
 Concentration
                                         Fatigue
Infection


Palpitation                            Weakness

                 Dizziness
                 Clinical Features
                               Pallor of skin
                                 And m/m
 Soft ejection
   systolic
   murmur                                       Edema

                      Signs
                                          Platynychia
Tachycardia                               Koilonychia

                   Glossitis
                  Stomatitis
         Causes of Anaemia

Physiological

Pathological

           Nutritional
           Haemorrhagic
           Haemolytic
             Iron Requirement

Iron Absorption               1
                        Amount of iron in the
                              body
                      Skin

                      Urine          1-2mg/d
Iron Loss
                      Feces

                  Menstruation      20-30mg/c
   Iron Requirement During Pregnancy


                                                32 to 40
                                                 weeks
                                20 to 32
                                 weeks         6.8 mg / day
                  Early
                Pregnancy      5.5 mg / day
                2.5 mg / day

                      RBC                      =500mg
    TOTAL             Fetus+Placenta           =450mg
800 – 1000 mg         Third stage blood loss   =200mg
                      Total                    = 1150mg
                          Normal Levels
Hb                              13.5 – 14 gm %

R.B.C.                          4.5 – 4.7 million/cu mm

Serum Iron                      50 – 150 μg / dL
TIBC                            300 – 360 μg / dL

Transferrin saturation          25 – 50 %
S. Ferritin level               30 μg / Lit

Red Cell protoporphyrin         30 μg / dL

Erythropoietin                  15.20 U / Lit

MCV                             76 – 100 fL

MCH                             27 – 33 pg
MCHC                            33.37 gm / dL

PCV                             32 – 40 %
              Laboratory Diagnosis of Anaemia

                      IDA           Thalassemia          Chronic Diseases

Serum Iron            Decreased     Normal / Increased   Decreased

TIBC                  Increased     Normal               Decreased or N

Transferrin           Decreased     N or Increased       N or Decreased
Saturation

Serum Ferritin        Decreased     N or Increased       N

Marrow Iron           Decreased /   N or Increased       N
                      absent
Therapeutic test with Rise in Hb    No rise in Hb        No rise
oral iron
                Nutritional Anaemia :
                Major Health Problems
          National Nutrition Anaemia Prophylaxis
              Programme (NNAPP 1971 - 72)


                               Pregnancy

FS + FA                        Lactating mothers

                               Family planning acceptors

                               Children – 1 to 11 years

     Anaemia continues – Major health problem
             Reason For Increased
             Incidence Of Anemia

   Poor pre-pregnancy iron balance due to –
    untreated systemic diseases & menstrual
    disorders
   Improper supplementation of iron in pregnancy
    ( late registration and poor follow up)
   Repeated childbearing
   Lack of awareness and illiteracy
               Reason For Increased
               Incidence Of Anemia
   Low socioeconomic status and poor hygiene

   Chronic malnutrition

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

   GI infections and infestations
    (e.g. Kala azar, worm infestations)
       Complications - Pregnancy

      IUGR                    CCF

                   PIH              INFECTION



IUD          IUH

                   Medical          PRETERM
                   Disorder          LABOUR
      Complications - Labour


                PPH
Instrumental               Foetal
   delivery     CCF       Distress



MATERNAL                 Morbidity
PERINATAL                Mortality
         Management Options

Pre – pregnancy :
 Treat the cause before conception
 Pre-pregnancy balanced diet, education
   and health support.
 Build up iron stores during adolescent
   phase
            Modalities of Management




                                          Blood
Oral Iron            Parenteral        transfusion




                              Human Recombinant
       Injectable Iron          Erythropoietin
                   Oral Iron
    100 mg elemental Iron ------- ↑ 0.18 gm % day

                  Iron absorption


Phosphate                  -ve                Worm
 phytate                                   infestation
                 ↓ Bioavailability
                      of Iron



                  Iron stores poor
                  Oral Iron Therapy
 Ideal dose – 100mg per day (prophylactic)
 Ferrous gluconate, ferrous fumarate, ferrous
  succinate, ferrous sulphate, ferrous ascorbate citrate
 Rise in Hb – 0.8 gm / dl / week
 Side effects -G I upset most common
 Pt. compliance not guaranteed
 Ineffective in pts with worm infestations
 Inconclusive evidence on benefit of controlled release
  Iron preparation
                 Absorption of Ferrous Salts
                   Uncontrolled Passive Absorption
     Iron salts are dissociated into bivalent or trivalent iron salts
     Diffuses as free iron ions through the upper pa
				
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