Anemia y embarazo/Pregnancy and anemia

Anemia y embarazo; implicaciones anestésicas


Anaemia and pregnancy: Anaesthetic implications.
Grewal A.
Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Indian J Anaesth. 2010 Sep;54(5):380-6. doi: 10.4103/0019-5049.71026.
Abstract
Anaemia in pregnancy defined as haemoglobin (Hb) level of < 10 gm/dL, is a qualitative or quantitative deficiency of Hb or red blood cells in circulation resulting in reduced oxygen (O2)- carrying capacity of the blood. Compensatory mechanisms in the form of increase in cardiac output (CO), PaO(2), 2,3 diphosphoglycerate levels, rightward shift in the oxygen dissociation curve (ODC), decrease in blood viscosity and release of renal erythropoietin, get activated to variable degrees to maintain tissue oxygenation and offset the decreases in arterial O(2) content. Parturients with concomitant medical diseases or those with acute ongoing blood losses may get decompensated, leading to serious consequences like right heart failure, angina or tissue hypoxemia in severe anaemia. Preoperative evaluation is aimed at assessing the severity and cause of anaemia. The concept of an acceptable Hb level varies with the underlying medical condition, extent of physiological compensation, the threat of bleeding and ongoing blood losses. The main anaesthetic considerations are to minimize factors interfering with O(2) delivery, prevent any increase in oxygen consumption and to optimize the partial pressure of O(2) in the arterial blood. Both general anaesthesia and regional anaesthesia can be employed judiciously. Monitoring should focus mainly on the adequacy of perfusion and oxygenation of vital organs. Hypoxia, hyperventilation, hypothermia, acidosis and other conditions that shift the ODC to left should be avoided. Any decrease in CO should be averted and aggressively treated.
KEYWORDS: Anaemia, anaesthetic considerations, compensatory mechanisms, pregnancy


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991646/
http://www.ijaweb.org/temp/IndianJAnaesth545380-3543212_095032.pdf


Terapia con hierro sucrosa intravenoso para anemia moderada a severa en el embarazo

Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy.
Kriplani A, Mahey R, Dash BB, Kulshreshta V, Agarwal N, Bhatla N.
Indian J Med Res [serial online] 2013 [cited 2013 Aug 6];138:78-82.
Abstract
Background & objectives: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement. In India, women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. Pregnant women with moderate anaemia are to be treated with parentral iron therapy. This study was undertaken to evaluate the response and effect of intravenous iron sucrose complex (ISC) given to pregnant women with IDA. Methods: A prospective study was conducted (June 2009 to June 2011) in the department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. One hundred pregnant women with haemoglobin between 5-9 g% with diagnosed iron deficiency attending antenatal clinic were given intravenous iron sucrose complex in a dose of 200 mg twice weekly schedule after calculating the dose requirement. Results: The mean haemoglobin raised from 7.63 ± 0.61 to 11.20 ± 0.73 g% (P<0.001) after eight wk of therapy. There was significant rise in serum ferritin levels (from 11.2 ± 4.7 to 69 ± 23.1 μg/l) (P<0.001). Reticulocyte count increased significantly after two wk of starting therapy (from 1.5 ± 0.6 to 4.6±0.8%). Other parameters including serum iron levels and red cell indices were also improved significantly. Only one woman was lost to follow up. No major side effects or anaphylactic reactions were noted during study period. Interpretation & conclusions: Parentral iron therapy was effective in increasing haemoglobin, serum ferritin and other haematological parameters in pregnant women with moderate anaemia. Intravenous iron sucrose can be used in hospital settings and tertiary urban hospitals where it can replace intramuscular therapy due to injection related side effects. Further, long-term comparative studies are required to recommend its use at peripheral level.
Keywords: Anaemia - iron deficiency - iron sucrose complex - parentral iron therapy - serum ferritin


http://www.ijmr.org.in/text.asp?2013/138/1/78/116208


http://www.ijmr.org.in/temp/IndianJMedRes138178-3451514_093515.pdf



Anemia, uso de hierro prenatal, y riesgos adversos del embarazo: revisión sistemática y meta-análisis
Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW; Nutrition Impact Model Study Group (anaemia).
Departments of Epidemiology and Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
BMJ. 2013 Jun 21;346:f3443. doi: 10.1136/bmj.f3443.
Abstract
OBJECTIVES: To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adversepregnancy outcomes; and to evaluate potential exposure-response relations of dose of iron, duration of use, and haemoglobin concentration in prenatal period with pregnancy outcomes.....
CONCLUSIONS: Daily prenatal use of iron substantially improved birth weight in a linear dose-response fashion, probably leading to a reduction in risk of low birth weight. An improvement in prenatal mean haemoglobin concentration linearly increased birth weight.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689887/pdf/bmj.f3443.pdf






Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org