RAMSAY SIME DARBY HEALTHCARE COLLEGE

DIPLOMA IN MEDICAL ASSISSTANT

SEMESTER 5

INDIVIDUAL ASSIGNMENT

INTAKE: DMA SEPT 2015

SUBJECT CODE:

SUBJECT NAME: MCH

NAME:NORSHAHIDAH BINTI ZAINAL

ID: SD01-201704-002565

ACADEMIC FACILATOR: Ms. ROSMARINA BT SEKOF

DEFINITION
Anemia is a medical condition in which there is not enough healthy red
blood cells to carry oxygen to the tissues in the body. When the tissues do
not receive an adequate amount of oxygen, many organs and functions are
affected. Anemia during pregnancy is especially a concern because it is
associated with low birth weight, premature birth and maternal mortality.
Women who are pregnant are at a higher risk for developing anemia due to
the excess amount of blood the body produces to help provide nutrients for
the baby. Anemia during pregnancy can be a mild condition and easily
treated if caught early on. However, it can become dangerous, to both the
mother and the baby, if it goes untreated.

PATHOPHYSIOLOGY

 Anemia is a condition that develops when your blood lacks enough healthy red blood
cells or hemoglobin.
 Hemoglobin is a main part of red blood cells and binds oxygen.
 When you're pregnant, you may develop anemia.
 When you have anemia, your blood doesn't have enough healthy red blood cells to carry oxygen
to your tissues and to your baby.
 During pregnancy, your body produces more blood to support the growth of your baby.
 If you're not getting enough iron or certain other nutrients, your body might not be able to
produce the amount of red blood cells it needs to make this additional blood.
 It's normal to have mild anemia when you are pregnant.
 Anemia can leave you feeling tired and weak. If it is severe but goes untreated, it can increase
your risk of serious complications like preterm delivery.

TYPES OF ANAEMIA DURING PREGNANCY

Several types of anemia can develop during pregnancy. These include:
 Iron-deficiency anemia
 Folate-deficiency anemia
  Vitamin B12 deficiency

Iron-deficiency anemia
This is the leading cause of anemia in the United States, and consequently, the most
common type of anemia during pregnancy. Approximately 15% to 25% of all pregnancies
experience iron deficiency. Iron is a mineral found in the red blood cells and is used to
carry oxygen from the lungs to the rest of the body, as well as helps the muscles store and
use oxygen. When too little iron is produced, the body can become fatigued and have a
lowered resistance to infection. Learn more about how to treat iron deficiency naturally
during your pregnancy .

Folate-deficiency anemia
Folate refers to Folic Acid , which is a water-soluble vitamin that can help prevent neural
tube defects during pregnancy. Folic Acid is a common supplement taken by pregnant
women, but it can also be found in fortified foods such as cereals, leafy vegetables,
bananas, melons, and legumes. A diet lacking folic acid can lead to a reduced number of
red blood cells in the body, therefore leading to a deficiency.

Vitamin B12 deficiency anemia

Vitamin B-12 is also a necessary vitamin for the body to have to help with the production
of red blood cells. Although some women may consume enough B-12 in their diet, it is
possible their body cannot process the vitamin, and this causes them to have the
deficiency.

PATHOPHYSIOLOGY

 This condition occurs when you don’t have enough red blood cells to carry oxygen to
 tissues in your body.
 When you lack sufficient red blood cells to move oxygen throughout your body, it
has an impact on your organs and bodily functions.
 Mild anemia may make you feel exhausted, but it can become serious if it becomes
too severe or is left untreated.
 In fact, anemia during pregnancy can lead to premature birth and low birth weight for
your baby, and even maternal mortality.

CAUSES OF ANAEMIA IN PREGNANCY

The cause of anemia truly comes down to how many red blood cells are being produced
in the body and how healthy they are. A fall in hemoglobin levels during pregnancy is
caused by a greater expansion of plasma volume compared with the increase in red cell
volume. This disproportion between the rates of increase for, plasma and erythrocytes has
the most distinction during the second trimester .
The following are ways red blood cells can be affected and lead to anemia:

 A lack of iron in the diet as a result of not eating enough iron-rich foods or the body’s
inability to absorb the iron being consumed. Learn more about how to get iron naturally.
 Pregnancy itself because the iron being produced is needed for the woman’s body to
increase her own blood volume. Without an iron supplement, there is not enough iron
to feed the blood supply of the growing fetus.
 Heavy bleeding due to menstruation, an ulcer or polyp, or blood donation causes red
blood cells to be destroyed faster than they can be replenished

RISK FACTOR OF ANAEMIA IN PREGNANCY

► Twin or multiple pregnancy

► Poor nutrition (iron/multivitamin/protein deficiency)
 ► Smoking (it reduces absorption of essential nutrients)
► Excessive alcohol consumption (it leads to poor nutrition)
► Use of anticonvulsant medications
► Morning sickness severe enough to cause frequent vomiting
► Spacing between two pregnancies is short
► Heavy menstrual flow before pregnancy

SIGN AND SYMPTOM OF ANAEMIA IN PREGNANCY

Symptoms of anemia during pregnancy can be mild at first and often go unnoticed.
However, as it progresses, the symptoms will worsen. It is also important to note
that some symptoms can be due to a different cause other than anemia .

Some common symptoms of anemia are:

 Weakness or fatigue

 Dizziness
 Shortness of breath
 Rapid or irregular heartbeat
 Chest Pain
 Pale skin, lips, and nails
 Cold hands and feet
 Trouble concentrating

DIAGNOSTIC

You may experience all or none of these symptoms if you have anemia during your pregnancy.
Fortunately, blood tests to screen for anemia are routine during prenatal care. You can expect to be
tested early in your pregnancy, and usually once more as you move closer to your due date.

Blood Tests

There are other tests that may be performed. Hemoglobin electrophoresis detects the
different types of hemoglobin that are present. A reticulocyte count assesses how well and
how quickly RBCs are manufactured. Serum iron, serum ferritin, total iron-binding
capacity, and transferrin level are tests that assess different measures of iron status.

Complete Blood Count

A CBC, is often the first test that is ordered to confirm or rule out many illnesses. This
test measures the level of hemoglobin in RBCs. It measures hematocrit, which is a ratio
of the volume of RBCs compared to the total blood volume. The test also measures the
levels of RBCs, WBCs, and platelets. Abnormal values of these may help diagnose an
illness. Normal levels of these values may differ somewhat according to ethnic heritage.
Another measure that may be assessed with a CBC is mean corpuscular volume (MCV).
This measure determines the average size of RBCs.

TREATMENT OF ANAEMIA IN PREGNANCY

Supplements

Mild to moderate deficiency may be treated with a variety of dietary changes and
supplements. Ferrous is a form that is more easily absorbed than ferric. The mineral is
best absorbed when taken with a meal and along with vitamin C. Orange juice is a good
thing to consume along with the supplement to aid absorption. Folic acid and vitamin
B12 are also necessary to manufacture healthy RBCs. The doctor may recommend eating
a diet rich in folate and vitamin B12 or supplementing these necessary nutrients.
Blockers

Some substances in certain foods, beverages, and supplements may interfere with the
ability to absorb enough iron. Calcium blocks the absorption of the mineral. If you take
calcium, ask the doctor how many hours you should take it away from other supplements
you take. Do not take supplements with coffee or tea. These beverages contain substances
that may inhibit absorption.

Transfusion

In the event of severe deficiency and/or if there has been a lot of blood loss, a transfusion may be
necessary. Blood loss may occur during surgery, due to an injury, or during or after childbirth. The
recipient's blood is “typed” prior to transfusion to ensure a compatible blood type is used. In the event
of an emergency, universal donor blood is transfused into the patient. Blood is transfused via an IV
and it takes between 1 and 4 hours.

COMPLICATION
Women with anaemia in pregnancy have been shown to have a higher risk of:
 Maternal death.
 Fetal death.
 Premature delivery.
 Low birth-weight babies.
 Cardiac failure.
 Their babies having subsequent developmental problems.
 Poor work capacity/performance.
 Susceptibility to infection.
HEALTH EDUCATION
1. Prenatal vitamins
Prenatal vitamins usually contain iron and folic acid. Taking a prenatal vitamin once a day is an easy
way to get essential vitamins and minerals for sufficient red blood cell production.
2. Iron supplements
If you’re testing positive for low iron levels, your doctor may recommend a separate iron
supplement in addition to your daily prenatal vitamin. Pregnant women need around 27
milligrams of iron daily. But depending on the type of iron or iron supplement consumed,
the dose will vary. Talk to your doctor about how much you need.

You should also avoid eating foods high in calcium while taking iron supplements. Food
and beverages like coffee/tea, dairy products, and egg yolks can prevent your body from
properly absorbing the iron.

Antacids can also interfere with proper iron absorption. Be sure to take iron two hours
before or four hours after you take antacids.

3. Proper nutrition
Most women can get sufficient amounts of iron and folic acid during pregnancy by eating
the right foods. Good sources of these essentials minerals include:

 poultry

 fish
 lean red meats
 beans
 nuts and seeds
 dark leafy greens
 fortified cereals
 eggs
 fruits like bananas and melons

Animal sources of iron are the most easily absorbed. If your iron is coming from plant
sources, supplement them with something high in vitamin C, like tomato juice or oranges.
This will help with absorption
PATIENTS PARTICULARS:
1. MEDICAL RECORD:125244
2. NAME:HALIPAH BT NASIR
3. GENDER:FEMALE
4. AGE:39 YEARS OLD
5. ETHNIC:MALAY
6. OCCUPATION:HOUSEWIFE
7. OBSTESTRIC SCORE :G8P7
8. WEIGHT:58.9KG HEIGHT:149.8CM BMI:25.7
9. DIAGNOSIS:ANAEMIA DURING PREGNANCY

Chief complaint:
Easy fatigability since 2 month.

History of present illness:

Patient presents with easy fatigability since 2 months.Previously pregnant also get mild
anaemia.
Otherwise:BO normal
:No fever
:PU normally
:No URTI/UTI
:No LOA/LOW
:No altered bowel habit
:No sob,chest pain,palpitation
O/E:Alert,tachypniec
BP:115/67mmHg
PR:76 bpm
RR:20 bpm
T:36 c

PATIENT HISTORY

 Past medical history(PMHx):

 Do not have any past medical history
 Past Surgical History(PSHx):
 Do not have any past surgical history
 Medication
 Oral contraceptive pill usage in 2014
 Social history
 Live with husbands and children
 Non smoker,non alcoholic
 Family History
 Do not have any history of DM,HPT
 Menstrual History
 Age of menarche-13 years old
 Cycle-Regular 30 cycles with flow lasting 5 days
 normal quantity,no pain or passing of clots
 Obstetric history:
 LMP-
 EDD-20/11/1017
 G8 P7
NO YEAR WEEK SVD/LCS GENDER WEIGHT COMPLICATION CONDITION OF
BABY
1 1999 36/52 SVD full GIRL 2.8kg GOOD
term
2 2001 34/52 SVD full GIRL 2.5kg GOOD
term
3 2003 34/52 SVD full GIRL 2.9kg GOOD
term
4 2005 38/52 SVD full BOY 3.30kg GOOD
term
5 2007 36/52 SVD full GIRL 3.0kg GOOD
term
6 2010 36/52 SVD full GIRL 2.78kg GOOD
term
7 2015 34/52 SVD full BOY 3.05kg GOOD
term
8
PHYSICAL EXAMINATION

Head to Toe(oral,throat,ear,eye and nasal):

HEAD:Normal
BREAST:Nipple is normal,no lump
ORAL:Normally distributed teeth,absense of halitosis,tougue is coated
THROAT:No swelling or inflammation
EAR:Ears are symmentrical,absence of discharge,hearing is normal
EYE:Vision is normal,sclera and conjunctiva normal
NASAL:No discharge present

Neck:
 Normal range of motion of neck
 Absence of lymph node enlargement
 Absence of tyroid enlargement

Chest region:
Heart:
 Normal heart sound (lub dub sound)
 Regular rhythm and good volume
 No palpitation
 No murmur sound
 No chest pain or discomfort

Lungs:
 Breathing normally
 Clear lung
 Chest symmentry during respiration not asymmetrical
 No crepitation
 No chest deformities
Abdomen:
 Soft
 No mass
 Bowel sound present,not hyperactive
 No enlarged of liver,spleen or kidney
 No scar over the abdomen
 Fundus heigth 25cm
 No abnormalities noted

Nervous system:
 Sensation normal
 Patient was alert and concious
 No cyanosis
 No clubbing of fingers
 Patient is ability to walk

Upper&lower limbs:
 No upper limb swelling
 Function normally
 No edema

Genital&rectum:
 Normal bowel habits
 No discharge or swelling in the genita or rectum
Investigation

BLOOD INVESTIGATION:
FBC
WBC
HB
HAEMATOCRIT

URINE:
ALBUMIN ABSENT
SUGARA ABSENT

PROVISIONAL DIAGNOSIS:
DIFFERENTIAL DIAGNOSIS:
DIAGNOSIS:ANAEMIA IN PREGNANCY

MANAGEMENT
EARLY MANAGEMENT MEDICATION NURSING CARE
Follow up ANC T.Ferous Fumarate 1/1 OD  Monitor HB
T.folid acid 5mg OD  Assists the patient in
developing a schedule
for daily activity and
rest.
 Instruct the patient
about medication/diet
that may stimulate RBC
production
 Educate energy
conservation techniques

HEALTH EDUCATION

 Take balanced diet that rich in iron

 Take more fruit,leafty vegetables
 Continue haematinics:folid acid
 Continue follow up ANC
 Drink milk 2 glass per day
 Avoid caffein drink
 Avoid do any haevy work