Moderate to severe maternal anaemia in pregnancy and its impact on perinatal outcome in tertiary care hospital

Background: Anaemia is the commonest medical disorder in pregnancy and has a varied prevalence, etiology and degree of severity in different populations. The purpose of this study was to evaluate the prevalence of maternal anaemia in pregnancy and its impact on perinatal outcome.Methods: This was a prospective observational study conducted in department of obstetrics and gynecology JLN Hospital Ajmer, Rajasthan, India from October 2015 to December 2016. Total 325 pregnant women were included in the study who fulfilled the inclusion criteria and found to have moderate to severe anaemia.Results: Prevalence of anaemia in pregnancy was 80% in present study. Perinatal mortality was 13.3% in moderate anaemia and in severe anaemia 42%. In present study maximum 56% of cases were in the age group of 20-25 years, and maximum number of cases were primigravida (33.84%). Out of 225 cases of moderate anaemia only 50 cases (22.22%) had antenatal check-up once or twice. Out of 225 cases of moderate anaemia, 66.66% cases were rural and 33.33% cases were of urban group. Fetal outcome in present study was in form of 49.23% premature birth with 33.12% perinatal mortality.Conclusions: Maternal anaemia in pregnancy is associated with illiteracy, low socioeconomic status, multiparity, inadequate antenatal care and rural geographic area.  Severe anaemia was associated with high perinatal mortality.

The modern implementation of patient blood management (PBM) in Malaysia: the use of intravenous iron in severe anaemia with iron deficiency – A Case Report

Anaemia is a common condition in Malaysia, and is mostly due to iron deficiency. In many cases, allogeneic blood transfusion (ABT) is administered unnecessarily to treat anaemia. Patient blood management (PBM) is a concept whereby a patient becomes his or her “own blood bank”, instead of receiving ABT. The concept encompasses three pillars namely optimising erythropoiesis, minimising blood loss and harnessing human physiological reserve. We present a safe and fruitful outcome of managing severe anaemia without utilising any ABT, made possible with the PBM approach including administration of intravenous iron.

Anemia severa causada por Necator americanus: reporte de un caso / Severe anemia caused by Necator americanus: case report

En climas templados, yungas (zona intermedia entre valle y trópico) y trópico, prevalecen dos parásitos hematófagos: Necator americanusy Ancylostoma duodenale, responsable de una anemia crónica, que lleva a los niños a tener niveles tan bajos de Hb, que a veces sonconsiderados incompatibles con la vida; rara vez originan sangrado agudo severo.Describimos el caso de un niño, de seis meses de edad, procedente de Coroico (Nor Yungas) con disentería inicial, misma que luego secomplica con melenas y rectorragia de sangre rutilante que origina una hipovolemia severa, rayana en el choque. Sometido a exploraciónquirúrgica por persistencia del sangrado, previo gammagrafía para descartar un divertículo de Meckel, no se halla el sitio de sangradopor lo que se realiza laparotomía exploratoria y posteriormente una endoscopía, identifi cándose en duodeno foco de sangrado originadopor parásitos, que por su morfología se asume que se trate de Necator americanus. Con este diagnóstico, recibe transfusiones para suestabilizar su hipovolemia y Mebendazol, con buena evolución, remisión del sangrado de tubo digestivo, y buena tolerancia a la alimentación.El “sangrado agudo” por uncinarias, es excepcional, hecho que justifi ca la presentación del caso y permite realizar un recordatorio breve delos mecanismos responsables de ello...

In temperate climate, yungas (intermediate zone between valley and tropical lowland), two blood sucking parasites are prevalent: Necator americanus and Ancylostoma duodenale, responsible for chronic anaemia in children that causes extremely low Hb levels sometimesconsidered as incompatible with life; only in rare cases acute bleeding occurs.We describe the case of a six months old child stemming from Coroico (Nor Yungas) initially with dysentery that becomes complicated by melaena and rectal bleeding originating severe hypovolaemia bordering on shock. After gammagraphy in order to exclude Meckel’s diverticle, the child was submitted to surgical exploration, where no source of bleeding could be found, therefore an explorative laparotomy was performed and later on an endoscopy, where the source of bleeding was identifi ed in the duodenum as caused by the parasite Necator Americanus. With this diagnose, blood transfusions were administered to the child in order to stabilize the hypovolaemia and Mebendazol was given. The evolution was good, the bleeding stopped and feeding was well tolerated.Acute bleeding caused by hook worms is exceptional; therefore we present this case as a short reminder of the responsible mechanisms.