Anemia: Understanding The Concepts

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

You can read the complete algorithm of anemia here.


“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”.


It is classified into two:

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

Causes of Anemia During Pregnancy

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

Clinical Features


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

In examination

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

Diagnosis of a Case of Iron Deficiency Anemia

  1. Hematological examination
    • Hemoglobin
    • Total red cell count
    • Packed cell Volume
    • Peripheral blood smear
    • MCHC, MCB, and MCH values
    • Serum Iron
    • Total iron binding capacity
    • Serum ferritin
  2. Examination of stool
    • To detect anemia due to hookworm infestation
    • Urine examination
  3. To check infection and presence of protein, sugar, and pus cell

Complications of Severe Anemia

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

Nursing Management

  1. The pregnant woman should get her hemoglobin level checked at the first antenatal visit, then at the 28th week, and finally at the 36th week.
  2. The mother should be given an iron protein and vitamin-rich diet like:
    • Liver
    • Meat
    • Egg
    • Green vegetable
    • Figs
    • Beans
    • Whole wheat
    • Green Plantains
    • Onion stalks
    • Jaggery
    • 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 emphasized and reinforced as told earlier like a richer source of iron and folic acid are to be given taken before, during, and after pregnancy.
  6. While administration of parenteral iron checks for advert reactions like rigor chest pain, and hypertension.

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