Orientation of Medical Officers on Anaemia during Pregnancy

Orientation of Medical Officers on Anaemia during Pregnancy, Rajasthan Case Exercises on Anaemia during Pregnancy Session 2. 2

Case 1 22 years old Geeta, primigravida comes to your OPD at CHC with 7 months amenorrhoea with complaints of weakness, lethargy and breathlessness on little work since 15 days. Question: What will you do next?

Case 1 contd. Possible Response Prompts • Take history- LMP, current obstetric history, geographic location of residence, socio- economic background, dietary intake, previous H/O any blood transfusion (BT), H/O taking supplements in this pregnancy • According to her LMP she is 27 weeks pregnant, not residing in malaria endemic zone, no H/O BT, coming first time for ANC and has not taken any supplements • General examination- Pallor, oedema, vitals • O/E-pallor+, pedal oedema +, pulse 98/min, temperature-370 C, respiratory rate 22/min, and BP is 110/70 mm Hg Question: What investigations will you advice?

Case 1 contd. Possible Response • Since she is coming for the first time, I will advise Hb, urine for protein, sugar and AFB, OGTT, HIV, HBs. Ag, syphilis, blood group • Besides this since she is looking pale so I will advise for peripheral smear (PS) for MP, TLC, DLC, Platelets, MCV, Peripheral smear for RBC morphology (if available) Prompts • Her Hb is 8 gm%, urine albumin, sugar-nil. Rest reports awaited. • O/E-pallor +, pedal oedema +, pulse 98/min, temperature-370 C, respiratory rate 22/min, and BP is 110/70 mm Hg Question: What is your probable diagnosis? Answer: Moderate anaemia Question: How will you proceed to manage this case?

Case 1 contd. Response: Management of moderate anemia: • Tablet Albendazole 400 mg stat by DOTS • Start Injection Iron sucrose regime • Counselling on her condition, diet, hand hygiene, safe drinking water • Counselling on importance of adhering and completing treatment • Counselling on institutional delivery Result: Great! Correct response.

Case 2 Reena, 28 years old second gravida, comes to your PHC for her third follow up ANC visit. She was diagnosed with anemia as her Hb level was 10 gm% during her second ANC visit and was advised to take tablet IFA twice a day. Question: What will you do next?

Case 2 contd. Prompts Possible Response • Ask for compliance • Perform general examination for pallor, oedema, vitals • Perform abdominal examination for appropriate growth of fundal height (foetal growth) • She says she is taking the advised tablets regularly. • O/E-pallor +, pedal oedema +, pulse 98/min, temperature-370 C, respiratory rate 22/min, and BP is 110/70 mm Hg • Her fundal height is according to her gestational age Question: What investigations will you advice? • Repeat her Hb. • Haemoglobin is 9 gm% Question: What are the possibilities of fall in Hb? What will you do next?

Case 2 contd. Possible Response: Since she is not responding to oral iron therapy, possibilities are: • Non compliance • Unresponsive to iron absorption I will refer her to higher facility for further evaluation to rule out other causes of anemia and further management accordingly Result: Great! Correct response.

Case 3 Meena, 4 th gravida comes to you at the district hospital for her 1 st ANC visit with her sister. She is 8 months pregnant. She is complaining of extreme weakness, swelling over body, breathlessness, giddiness since 1 month. Question: What will you do next?

Case 3 contd. Possible Response Prompts • Take history- LMP, past and current obstetric history, spacing between pregnancies, geographic location of residence, socio- economic background, dietary intake, previous H/O any blood transfusion (BT), H/O taking supplements in this pregnancy • According to her LMP she is 36 weeks pregnant, not residing in malaria endemic zone, no H/O BT, coming first time for ANC and has not taken any supplements • General examination- Pallor, oedema, vitals • O/E-pallor ++, oedema + over face hands and feet, pulse 110/min, temperature-370 C, respiratory rate 28/min, and BP is 110/70 mm Hg Question: What investigations will you advice?

Case 3 contd. Possible Response • Since she is coming for the first time, I will advise Hb, urine for protein, sugar and AFB, OGTT, HIV, HBs. Ag, syphilis, blood group • Besides this since she is looking pale so I will advise for peripheral smear (PS) for MP, TLC, DLC, Platelets, MCV, Peripheral smear for RBC morphology (if available) Prompts • Her Hb is 5 gm%, urine albumin and sugar-nil. Rest reports awaited. • O/E-pallor +, pedal oedema +, pulse 98/min, temperature-370 C, respiratory rate 22/min, and BP is 110/70 mm Hg Question: What is your probable diagnosis? Answer: Severe anaemia Question: How will you proceed to manage this case?

Case 3 contd. Possible Response: I will manage her as for severe anemia: • Admit her and inform Meena and her attendant/family about her condition and its effects on her and the baby’s well-being and need for blood transfusion • Take blood for grouping and cross matching • Arrange blood and start transfusion • Give tablet Albendazole 400 mg stat by DOTS • Counsel her on need to complete the treatment, diet, hand hygiene, safe drinking water • Counsel her on institutional delivery Result: Great! Correct response.

Thank you