缺铁性贫血和妊娠的病理生理和麻醉考虑一个更新

Sunanda Gupta, Karuna Sharma, Charu Sharma, A. Chhabra, Lalita Jeengar, Nitasha Sharma
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引用次数: 0

摘要

贫血在怀孕期间很常见,特别是在低收入和中等收入国家,缺铁是全世界最常见的贫血原因。与缺铁有关的症状可能多种多样,这些症状与不同组织器官中细胞铁功能的耗竭有关,并且可能在缺铁限制红细胞生成和贫血发生之前很久就存在。了解贫血期间发生的病理生理和适应性变化是很重要的,因为长期的变化会影响各种器官系统,并可能影响孕产妇和新生儿的结局。越来越多的证据表明,母体IDA与随后的新生儿认知和神经行为结果有关,因此必须在妊娠早期治疗IDA。术前优化铁治疗(口服或静脉注射)和促红细胞生成剂与输血补充o2携带能力必须始终平衡与输血相关的风险。严重贫血产妇的麻醉管理取决于多种因素,如缺铁性贫血的严重程度、合并症、生理代偿程度以及预期出血的类型和性质。本文综述了妊娠IDA患者的病理生理变化和适应,包括氧输送和铁稳态、治疗管理和麻醉挑战。它基于Ovid Medline, Ovid Embase和PubMed(截至2021年6月)的电子搜索策略以及相关的学院和社会基于网络的资源,包括皇家妇产科学院和麻醉学家,国家健康和临床卓越学院和社会研究所(NICE),患者血液管理指南和美国妇产科学院(ACOG)实践公告。
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Pathophysiologic and anaesthetic considerations in iron deficiency anaemia and pregnancy; An update
Anaemia is common during pregnancy, especially in low- and middle-income countries, and iron deficiency is the most common cause of anaemia worldwide. Symptoms relating to iron deficiency can be diverse, which relate to the depletion of cellular Fe function in different tissue organs and may exist long before Fe deficiency restricts erythropoiesis and anaemia develops. It is important to understand the pathophysiological and adaptation changes occurring during anaemia as long-standing changes affect the various organ systems and may impact both maternal and neonatal outcomes. There is growing evidence linking maternal IDA with subsequent neonatal cognitive and neurobehavioral outcomes, which makes it imperative that IDA should be treated early in pregnancy. Preoperative optimization with iron therapy (oral or parenteral) and erythropoiesis-stimulating agents vs replenishing O2-carrying capacity by transfusion must always be balanced against transfusion-associated risks. The anaesthetic management in parturients with severe anaemia depends on a multitude of factors, such as severity of iron deficiency anaemia, co-morbid diseases, extent of physiological compensation, and type and nature of anticipated haemorrhagic loss. This review summarizes the pathophysiological changes and adaptations consequent to oxygen delivery and iron homeostasis, therapeutic management, and anaesthetic challenges in pregnancy with IDA. It is based on electronic search strategies from Ovid Medline, Ovid Embase and PubMed (up to June 2021) along with relevant college and society web-based resources, including Royal College of Obstetricians and Anaesthesiologists, National Institute for Health and Clinical Excellence College and Society (NICE), Patient Blood Management Guidelines and American College of Obstetricians and Gynaecologists (ACOG) practice bulletins.
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29 weeks
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