Anemia in The Perinatal Period

Anemia is defined as a condition in which the blood does not have an adequate amount of healthy red blood cells or hemoglobin (a protein in the red blood cells that transports oxygen to other cells throughout your body). During the perinatal period, a woman’s body undergoes significant changes. One of those changes includes the amount of blood volume in your body, which increases by about 20-30 percent thus causing an increase on the demand of of iron and vitamins that the body needs to make hemoglobin (American Society of Hematology , 2017).

The deficiency of iron puts a person at risk to develop Iron deficiency anemia, especially during pregnancy where the need is increased yet unavailable.

Another form of anemia known as Sickle cell Disease (SCD) is also dangerous in the perinatal period. SCD is a group of inherited red blood cell disorders (a recessive genetically inherited disorder), which causes pain and other serious problems. In SCD the red blood cells become hard and sticky and look like a C-shaped farm tool referred to as a “sickle”.

The Sickle cells die early, which causes a shortage of red blood cells. Clotting can occur due to the red blood cells being hard and sticky, and causes a blockage in blood flow and results in the pain experienced with SCD. (Center for Disease Control and Prevention , 2017)

Both types of anemia have effects on the mother and the fetus such as a higher risk of preterm labor and having a low birth weight baby.

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Severe iron deficiency anemia can put your baby at higher risk for anemia later in infancy. The mother is at risk of blood loss during labor and making it more difficult to fight infections. Pregnancy can cause SCD to become more severe and pain episodes can occur more often. Early prenatal care and careful monitoring throughout pregnancy is important in order to accomplish a healthy pregnancy. Risk factors for Iron deficiency anemia include having two pregnancies close together, a pregnancy with more than one fetus, vomiting frequently due to morning sickness, a lack of consumption of iron, and a heavy pre-pregnancy menstrual flow. SCD risk factor differ since it is inherited, people of African descent, including African-Americans, whom which according to statistics 1in 12 carry a sickle cell gene and, according to ASH 8% of African Americans are affected by the inherited trait SCD. (American Society of Hematology , 2017). Hispanic/Americans from Central and South America, and people of Middle Eastern, Asian, Indian, and Mediterranean descent are also affected and carriers of the recessive trait.

Common signs and symptoms of iron deficiency anemia include such as shortness of breath, weakness, brittle nails or spooning of the nails pale skin, and coldness in the hands and feet. Some people also report unusual cravings such as the craving of ice, dirt paint and starch. SCD can be mild or severe enough to require frequent hospitalization. Signs and symptoms include pale skin, dark urine, yellow eyes, painful swelling of hands and feet, pain episodes, stunned growth, and stroke.

Diagnostic testing and a health history is done during first prenatal appointment to help diagnose Iron deficiency anemia and Sickle Cell Disease. Screening for iron deficiency anemia includes a complete blood count (CBC) to observe the Hemoglobin, Red blood cells, Hematocrit, or the mean corpuscular volume. A decrease in these diagnostic studies would indicate anemia. Generally, all newborns in the United States are now being tested for SCD. (American Society of Hematology , 2017). During pregnancy prenatal testing is done to find out is a baby will have SCD or the trait, or neither. A chronic villus sampling (CVS) and amniocentesis often are used to find out if the baby will have the disease or carry the trait. These test usually are conducted after the second month of pregnancy. (Center for Disease Control and Prevention , 2017)

Women with sickle cell anemia are not iron deficient. Therefore routine iron supplementation, even that found in prenatal vitamins, should be avoided because these women can develop iron over-load. (Lowdermilk, Perry, & Cashion, 2014) Early prenatal care and monitoring during the pregnancy can assist a woman in having a healthy pregnancy. It is highly likely that problems during pregnancy can affect their health and that of their unborn baby. Hydroxyurea is a medication that is available to decrease several complications and prolong the lives of those who have SCD. Side effects of taking this medication during pregnancy are not completely identified. As a nurse pain control interventions should be implemented and the administration of opioids should be administered as prescribed. Oxygen should be administered as necessary to prevent sickling. Patient teaching should be done to prevent infections from occurring such as hand hygiene, vaccines being up to date and staying hydrated.

The nurse should take into consideration the need to receive a blood transfusion for both iron deficiency and SCD can be recommended if not already ordered and if it is necessary. Treatment for Iron deficiency anemia will depend on its cause and severity, Iron or B 12 supplements are recommended by a physician to be taken, especially during pregnancy. The Nurse can provide patient teaching on diet change and nutrition involving foods rich in the recommended amount of iron/ B 12 and vitamin C to help your body absorb iron. Other interventions and precautions the nurse should take would be oxygen administration when required and monitoring the oxygen saturation level of a person if dropped below 94% it is recommended to start the patient on 2L NC and increase as necessary. The nurse would also want to assess for bleeding especially for women, soaking more than 1 pad in an hour is concerning and should be reported. Fall precautions should also be implemented.

In conclusion anemia in pregnancy could result in dangerous outcomes for both the mother and baby, however women with iron deficiency anemia and SCD can have healthy pregnancies with the correct monitoring and lifestyle changes. Treatments are not available but supplements and medication are to help relieve the symptoms and ease complications. Testing is also done during prenatal checkups to help diagnose patients therefore patients are encouraged to follow appointments and teachings that are done in prenatal checkups. Extra monitoring may be taken depending on the severity or the condition.

References

1. American Society of Hematology . (2017, September 08). Anemia and pregnacy. Retrieved October 19, 2018, from hematology.org:
2. https://www.hematology.org/patients/anemia/pregnacy.aspx
3. Center for Disease Control and Prevention . (2017, August 9). Sickle Cell Disease (SCD) and Pregnacy. Retrieved October 18, 2018, from cdc.gov:
4. https://cdc.gov/ncbdd/sicklecell/pregnacy.html
5. Lowdermilk, D. L., Perry, S. E., & Cashion, M. C. (2014). Maternity nursing. Maryland Heights,
6. MO: Mosby/Elsevier .