In pregnancy occurs hematologic changes within certain limits are reasonable: hematologic changes that stand out are: a). Changes in blood plasma, b). Changes in blood cells, c). Due to changes in both of these will arise physiologic anemia.
a). Changes in blood plasma.
In pregnancy blood plasma volume will increase. The increase in the volume of blood plasma starting at 3 months of pregnancy, which is gradually increased until it reached a maximum rise at the gestational age of 32-34 weeks. Once the gestational age of 32-34 weeks later blood plasma volume decreases, and will reach normal volume after 3 weeks of giving birth.
If the pregnancy has reached even months, then the blood plasma volume increased by 45% from the state before pregnancy: Increase in plasma are due to placental lactogen stimulation that causes the increase in aldosterone secretion.
In pregnancy, blood plasma volume had to be increased in order to meet the needs of plasma fluid in the enlarged uterus, accompanied by enlargement of blood vessels. Besides the increase in plasma fluid is needed to maintain hemodynamic balance, on the bed or standing position and offset the loss of body fluids at the time of delivery.
b). Changes in blood cells.
Starting at the age of 8 weeks of pregnancy, the number of leukocytes increases progressively until term. In peripheral blood examination to be found mielosit and metamielosit, as a result of this lekositosis: When in pregnancy found the number of leukocytes 10: 000-15000, this is normal.
Platelets will rise during pregnancy. Several other investigators say that the platelet count remained, even a little lower than before pregnancy. But what is clear is when postpartum platelet count increases. At the age of 6 months of pregnancy, from an increase of erythrocytes and reached a peak at term pregnancies, who eventually returned to normal after 6 weeks of giving birth.
c). physiological anemia
Increasing the volume of blood plasma was not balanced by the increase in the number of erythrocytes. In a further development of the pregnancy, it was the increase in blood plasma volume higher than the increase in erythrocyte: When the increase in plasma volume reaches 35-55%, then the increase in erythrocyte only 15-30%. The result is a dilution of erythrocyte cells big enough, especially at the gestational age of 32-34 weeks so that relatively low levels of Hb becomes.
This dilution event called "hydraemia", "pseudo anemia" or commonly called "physiologic anemia". In the circumstances of this hemodilution, hemoglobin level could achieve a reduction to 10%, which can still be considered fisiologic. Actually, about the problems of hemodilution or pseudo anemia is still a lot of disagreement.
Many experts argue that what he regarded as actual hemodilution is really a manifestation of iron deficiency. This is because there are many pregnant women who from the beginning has been experiencing iron deficiency anemia. For example, in the land of England, 20% of pregnant women have been iron deficient since it began
Pregnant.
Investigators else disagrees with this, saying that the physiologic anemia have been no changes microcytosis or anisocytosis, and there will be a decrease in serum iron. Anyway it often happens that the addition of iron in anemia physiological do not produce elevated levels of hemoglobin. but once completed delivery in fact there is an increase in hemoglobin levels last opinion experts agree that the physiologic anemia should still be given iron supplements because of the addition of iron is not harmful.
