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How do I deal with a low RBC count during pregnancy?

Answered by: Dr. Shirish Kumar
Consultant Haematologist,
Sir Ganga Ram Hospital,
New Delhi

Q. I am in my ninth week of pregnancy. My routine blood test reveals a BC count of 13000 and low RBC count. Please advise.

A.  Pregnancy leads to many functional (physiological) and structural (anatomical) changes in the body. They occur due to the a) needs of the developing baby, placenta and the uterus, and b)increasing levels of pregnancy hormones especially progesterone and ostrogen. Anaemia is a condition in which the number of red blood cells (RBCs) or the amount of haemoglobin (Hb) is below normal for age and sex of the individual. It is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and haematocrit (Hct). Anaemia is suggested in pregnant women with Hb levels less than 11.5 g/dl. Anaemia during pregnancy occurs due to several reasons. The fluid content of the blood (blood volume) increases upto 50% while the red cells increase by only about 20-30% resulting in haemodilution i.e. relatively fewer red cells (& Hb) present in an increased volume of blood. This increase in blood volume helps in the exchange of respiratory gases, nutrients & other metabolic substances between the baby and the mother, increases perfusion of the uterus & kidney and it also compensates for the blood loss that will occur at the time of delivery. The magnitude of the increase in blood volume varies according to the size of woman, the number of pregnancies she has had, the number of infants she has delivered, and whether there is one or multiple fetuses. The developing baby needs iron, folic acid and vitamin B12 from the mother for its growth. Women thus need to take supplemental iron and folic acid to meet the needs of the baby and hence iron deficiency is very common. If supplemental iron is not added to the diet, iron deficiency anaemia will result. Maternal requirements can reach 5-6mg/day in the latter half of pregnancy. If iron is not easily available, the baby uses iron from maternal stores. Thus, the production of fetal haemoglobin is usually adequate even if the mother is severely iron deficient. This maternal iron deficiency may cause preterm labour and late spontaneous abortion. Deficiency of folic acid and vitamin B12 may also be seen in individuals on purely vegetarian diet. Physiological leukocytosis (increase in white blood cells) refers to a total leukocyte count above the normal, without the association of any known disease process. It is documented that the number of leukocytes in peripheral blood increases considerably during pregnancy. The WBC count may increase up to 15,000/µl (or even higher during labour and following delivery). The total mass of WBCs also increases to fill the increased blood volume. The reason for the increase in WBCs is unknown but is probably a hormonal response. In case you have no fever, sore throat, urinary problem or other symptoms suggestive of an infection, these counts are normal.

A.  Pregnancy leads to many functional (physiological) and structural (anatomical) changes in the body. They occur due to the a) needs of the developing baby, placenta and the uterus, and b)increasing levels of pregnancy hormones especially progesterone and ostrogen. Anaemia is a condition in which the number of red blood cells (RBCs) or the amount of haemoglobin (Hb) is below normal for age and sex of the individual. It is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and haematocrit (Hct). Anaemia is suggested in pregnant women with Hb levels less than 11.5 g/dl. Anaemia during pregnancy occurs due to several reasons. The fluid content of the blood (blood volume) increases upto 50% while the red cells increase by only about 20-30% resulting in haemodilution i.e. relatively fewer red cells (& Hb) present in an increased volume of blood. This increase in blood volume helps in the exchange of respiratory gases, nutrients & other metabolic substances between the baby and the mother, increases perfusion of the uterus & kidney and it also compensates for the blood loss that will occur at the time of delivery. The magnitude of the increase in blood volume varies according to the size of woman, the number of pregnancies she has had, the number of infants she has delivered, and whether there is one or multiple fetuses. The developing baby needs iron, folic acid and vitamin B12 from the mother for its growth. Women thus need to take supplemental iron and folic acid to meet the needs of the baby and hence iron deficiency is very common. If supplemental iron is not added to the diet, iron deficiency anaemia will result. Maternal requirements can reach 5-6mg/day in the latter half of pregnancy. If iron is not easily available, the baby uses iron from maternal stores. Thus, the production of fetal haemoglobin is usually adequate even if the mother is severely iron deficient. This maternal iron deficiency may cause preterm labour and late spontaneous abortion. Deficiency of folic acid and vitamin B12 may also be seen in individuals on purely vegetarian diet. Physiological leukocytosis (increase in white blood cells) refers to a total leukocyte count above the normal, without the association of any known disease process. It is documented that the number of leukocytes in peripheral blood increases considerably during pregnancy. The WBC count may increase up to 15,000/µl (or even higher during labour and following delivery). The total mass of WBCs also increases to fill the increased blood volume. The reason for the increase in WBCs is unknown but is probably a hormonal response. In case you have no fever, sore throat, urinary problem or other symptoms suggestive of an infection, these counts are normal.

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