Anemia: Understanding The Concepts




Anemia is the most mutual medical ailment of pregnancy. The occurrence of anemia in pregnancy ranges from 40-80 % in tropics likened to 10-20% in developed countries.

“Anemia is a reduction in red blood cells (erythrocytes) which in turn decrease the oxygen carrying capacity of the blood. It reflects an abnormality in red blood cell number, structure or function”.

According to WHO, “Anemia in pregnancy is present when the hemoglobin concentration in the peripheral blood is 11g/100ml or less. Keeping in mind the socio-economic status, the level is brought down to 10g/100ml or less”. Or “Anemia is defined as a reduction below normal in the number of red blood corpuscles per cubic millimeter, the quantity of hemoglobin and the volume of packed red cells per 100 ml of blood”.

Classification of Anemia


Anemia is classified into two:

  1. Physiological anemia of pregnancy.
  2. Pathological anemia: it is further divided into:
    1. Deficiency anemia (isolated or combined)
    1. Hemorrhagic
    1. Hemolytic (Lack of bile pigment in urine)
    1. Bone marrow insufficiency
    1. Hemoglobinopathies

Causes of Anemia During Pregnancy

  1. Inadequate iron reserve
  2. Increase demand of iron
  3. Disturbed metabolism
  4. Pre pregnant health status
  5. Condition requiring excess demand
  6. Faulty dietetic habit
  7. Iron loss

Clinical Features


  1. Lassitude and a feeling of exhaustion or weakness may be earlier manifestation.
  2. Anorexia
  3. Palpitation
  4. Indigestion
  5. Dyspnea
  6. Gigginess
  7. Swelling of leg
  8. Pallor of mucus membrane

In examination

  1. There is pallor glossitis and stomatitis.
  2. There may be adima of leg.
  3. A soft systolic mermer may be geared.
  4. Crepitation may be heard.

Diagnosis of a Case of Iron Deficiency/Anemia

  1. Hematological examination
    1. Hemoglobin
    1. Total red cell count
    1. Packed cell Volume
    1. Peripheral blood smear
    1. MCHC, MCB and MCH values
    1. Serum Iron
    1. Total iron binding capacity
    1. Serum ferritim
  2. Examination of stool
    1. To detect anemia due to hookworm infestation
  3. Urine examination
    1. To check infection and presence of protein, sugar and pus cell
Read more-   Calcium Regulation: Parathyroid hormone vs Calcitonin

Complication of Severe Anemia

  1. During pregnancy:
    1. Pre-eclampsia
    1. Intercurrent infection
    1. Heart failure
    1. Preterm labor
    1. Abortion
  2. During labor:
    1. Uterine inertia
    1. PPH
    1. Cardiac failure
    1. Shock
  3. During puerperium:
    1. Puerperal Sepsis
    1. Sub involution
    1. Failing lactation
    1. Puerperal Venus Thrombosis
  4. Effects on Baby:
    1. There is increased incidence of low birth weight
    1. There are chances of intra uterine death

Nursing Management

  1. The pregnant women should get her hemoglobin level checked at the first antenatal visit, then at 28th week and finally at 36th week.
  2. The mother should be given iron protein and vitamin rich diet like
    1. Liver
    1. Meat
    1. Egg
    1. Green vegetable
    1. Figs
    1. Beans
    1. Whole wheat
    1. Green Plantains
    1. Onions stalks
    1. Jaggery
    1. Ground nuts
  3. She should be given oral preparation in the form of tablets and capsules
  4. Advise the mother to continue iron preparation.
  5. Dietary advice must be anthesised and reinforced as told earlier like richer source of iron and folic acid are to be given taken before, during and after pregnancy.
  6. While administration of parenteral iron check for advert reaction like rigor chest pain, hypertension.


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