Anaemia - Symptoms & Treatment of Anaemia
Anaemia is due to a reduction either in the amount of blood in the body or in the haemoglobin level. The quantity of blood in the body is assessed by measuring the level of haemoglobin either in gm per 100 ml or as a percentage; 100 per cent is equivalent to 14 gm ( i.e., 1 gm = 7 per cent).
Antenatal care ensures that normal haemoglobin levels are maintained throughout pregnancy. If anaemia is allowed to develop in the antenatal period then it will almost certainly be present after delivery; therefore, the best insurance against postpartum anaemia is adequate antenatal care. In this respect anaemia is not different from most of the other complications of pregnancy.
An excessive blood loss at or immediately after delivery may also result in anaemia in the puerperium. The average quantity of blood lost at delivery varies from about 75 to 250 ml and this amount is unlikely to affect the level of haemoglobin adversely.However, if this amount of blood loss is exceeded, or if a woman loses 500ml or even 1 litre of blood, then postpartum anaemia is likely to develop.
Postpartum haemorrhage is now comparatively rare, although some instances are unavoidable. A blood loss of in excess of a litre at or after delivery may be an indication for blood transfusion. This will depend on the haemoglobin level prior to delivery and upon whether or not the woman has been affected by the blood loss. If her condition is stable, a haemoglobin estimation may be taken the next day to enable a decision to be made with regard to blood transfusion. If the haemoglobin level is 8 gm/dl or more, oral iron therapy may be all that is necessary but below this level transfusion should be considered. Blood transfusion is a safe practice but does carry a very small risk of transmitting infections such as hepatitis. For this reason transfusion is not undertaken without good rea-son. It is often preferable, however, to replace the blood loss so that the woman is fit and healthy in the puerperium rather than anaemic and likely to suffer from lethargy, weakness, and susceptibility to infection. Anaemia also makes lactation less efficient.
The midwife and doctor know all the haemoglobin levels during pregnancy and will therefore be aware of any tendency to anaemia. They will thus be warned to look out for any anaemia that might develop after delivery. Unsuspected anaemia may be the result of this tendency and an excessive blood loss at delivery, for example, in a Woman whose haemoglobin level has been just within the normal range during the latter part of pregnancy, that is about 74-75 per cent (or 11 g), and who loses slightly more than the expected amount of blood at delivery (about 300-400 mI).
Symptoms of anaemia
These are all rather indefinite. The complexion is pale and has a rather pasty appearance. Excessive tiredness associated with inadequate sleep, impatience, shortness of breath, irritability and lethargy as well as a feeling that everything is too much trouble, are all minor symptoms of anaemia. The nails, lips and also the inner aspect of the lower eyelid are a pale color. The pulse rate may remain persistently high, over 100 per minute, and this in itself is one of the most significant of all recordings in the puerperium.