MindMap Gallery Medicine-Anemia in pregnancy mind map
This is a mind map about medicine-pregnancy anemia, including the classification, impact, grading standards, diagnostic criteria, etc. of anemia during pregnancy.
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anemia during pregnancy
Classification
iron deficiency anemia
Overview
During pregnancy, iron is actively transported from the mother to the fetus. Maternal iron requirements increase, and iron absorption during pregnancy is lower than during non-pregnancy, often leading to insufficient iron storage in women's bodies. Therefore, iron deficiency anemia often occurs during pregnancy.
Clinical manifestations and diagnosis
Medical history
She had a history of chronic blood loss diseases such as menorrhagia; a history of long-term partial eclipse, vomiting in early pregnancy, and malnutrition caused by gastrointestinal disorders.
clinical manifestations
In mild cases, there are no obvious symptoms, or only the skin, lip mucosa, and palpebral conjunctiva are slightly pale; in severe cases, fatigue, dizziness, palpitation, shortness of breath, lack of appetite, abdominal distension, diarrhea, pale skin and mucous membranes, dry skin and hair, brittle nails, and oral cavity inflammation, glossitis, etc.
laboratory tests
Hemoglobin <110g/l., hematocrit <0.30; peripheral blood smear red blood cells showed low pigment and small cells.
Serum iron <6. 5umol/L (3.5ug/dl).
The ferritin decrease is less than 10ng/ml.
Bone marrow: The red blood cell system proliferates actively, mainly medium and late immature red blood cells. Red blood cell divisions are visible, and no stainable iron is seen.
treat
Eat more iron-rich foods during pregnancy
Dynamic monitoring of blood levels in each trimester of pregnancy
Medication and iron supplementation.
blood transfusion
5. Intrapartum and postpartum treatment
Parturients with severe anemia should have blood matched for later use.
Closely monitor the labor process to prevent it from being too long. Vaginal delivery can shorten the second stage of labor, but birth trauma should be avoided.
Actively prevent postpartum hemorrhage.
If bleeding is severe, blood transfusion should be done promptly.
Strict aseptic operation is performed during labor, and broad-spectrum antibiotics are used to prevent infection during and after delivery.
megaloblastic anemia
Overview
95% of this disease during pregnancy is caused by a lack of folic acid in pregnant women, and a small number of cases are caused by a lack of vitamin B12.
Clinical manifestations and diagnosis
1.Clinical manifestations
anemia
gastrointestinal symptoms
peripheral neuritis symptoms
other
2. Laboratory examination
The blood pictures of folic acid and vitamin B12 deficiencies are the same. Hb is often lower than 40g~60g/L, accompanied by thrombocytopenia and leukopenia.
The peripheral blood smear showed macrocytic anemia, mean red blood cell volume (MCV)>100fl, and mean hemoglobin content (MCH)>32pg. Neutrophils are too lobed, with more than 5 leaves.
Bone marrow appearance: megaloblastic red blood cell proliferation >10%, large red blood cells, and loose nuclear chromatin. The granulocyte system and megakaryocytic system also undergo megamorphosis.
If serum folic acid is measured <6.8mmol/L (3ng/ml) and red blood cell folic acid is <227mmol/L (100ng/ml), it can be determined to be folic acid deficiency anemia; if serum vitamin B12 is measured <90pg/ml, it can be determined to be vitamin B12 deficiency. .
treat
Strengthen nutritional guidance during pregnancy
folic acid supplement
Vitamin B12
When hemoglobin is <70g/L, a small amount of fresh blood or concentrated red blood cells should be transfused intermittently.
Avoid prolonging labor during delivery, prevent postpartum hemorrhage, and prevent infection.
aplastic anemia
Overview
It is a group of syndromes in which the reduction in the number and quality of bone marrow hematopoietic stem cells leads to hematopoietic disorders, resulting in a decrease in peripheral whole blood cells (red blood cells, white blood cells, platelets) as the main manifestation.
Clinical manifestations and diagnosis
clinical manifestations
Severe anemia is often accompanied by bleeding tendencies. The bleeding lesions are mostly limited to the skin and mucous membranes. In severe cases, subarachnoid hemorrhage or intracranial hemorrhage may occur.
Common infections
laboratory tests
Peripheral blood picture: pancytopenia, decreased reticulocytes.
Bone marrow picture: Bone marrow hematopoietic function is significantly reduced.
treat
Pregnancy
therapeutic abortion
supportive care
Glucocorticoid therapy
Prevent infection
labor period
Try to deliver vaginally as much as possible to shorten the second stage of labor and prevent excessive force in the second stage of labor, which may cause bleeding in important organs such as the brain or intracranial hemorrhage in the fetus. Appropriate midwifery is possible, but birth trauma must be avoided. After delivery, carefully check the soft birth canal and carefully suture the wound to prevent the formation of birth canal hematoma. For those with indications for obstetric surgery, it is advisable to remove the uterus during cesarean section to avoid postpartum hemorrhage and puerperal infection.
puerperium
Continue supportive therapy, use uterotonics to strengthen uterine contractions, prevent postpartum hemorrhage, and use broad-spectrum antibiotics to prevent infection.
Influence
to mother
Pregnant women with anemia have low resistance and poor tolerance to delivery, surgery and anesthesia, even if they have mild or moderate anemia. blood, pregnant women are also at increased risk during pregnancy and delivery
to the fetus
In the process of competition between the maternal bone marrow and the fetus for the uptake of maternal serum iron, fetal tissue dominates. Iron passes through the placenta by Transport from pregnant woman to fetus is one-way transport. Fetal iron deficiency is not severe. When pregnant women suffer from severe anemia, it is easy to cause Fetal growth restriction, fetal distress, premature birth or stillbirth will also have a certain impact on the fetus in the long term.
Grading standards
Mild 100-109g/L
Moderate 70-99g/L
Severe 40-69g/L
Extremely severe <40g/L
Diagnostic criteria
Maternal peripheral blood hemoglobin <110g/L and hematocrit <0.33 are anemia during pregnancy.