Anemije u ginekologiji i perinatologiji – novi stavovi
Sažetak
Anemija predstavlja globalni zdravstveni problem. Medju ženama je zastupljena kod 38% trudnica i 29% negravidnih žena. Najčešći oblik je sideropenijska anemija. Najčeći uzrok anemije u ginekologiji su abnormalna materična krvarenja koja se javljaju kao akutno, hronično i intermitentno krvarenje. U perinatologiji postoje specifične promene na nivou kardiovaskularnog i hematopoetskog sistema trudnice koje nameću razlićite kriterijume za dijagnozu anemije u odnosu na negravidno stanje. Osnovna promena je porast volumena krvi koji raste više na račun plazme spram volumena eritrocita. Volumen eritrocita raste za oko 33%, a takodje raste i broj retikulocita. Dva su osnovna pristupa dijagnostici anemije – kinetički pristup koji nastoji da utvrdi mehanizam koji je do anemije doveo i morfološki pristup koji deli anemije u odnosu na veličinu srednjeg volumena eritrocita i retikulocitnog odgovora. Terapija najčešće – sideropenijske anemije se vrši preparatima gvoždja (hemsko, dvovalentno i trovalentno gvoždje). U trudnoći je ono potrebno svim trudnicama ali samo u umerenim dozama. Ukupno antenatalno povećanje treba da iznosi oko 1000 mg. Da bi se ove potrebe zadovoljile u prvoj polovini trudnoće potrebno je 4 mg gvoždja dnevno a u drugoj polovini 6-7 mg. Zbog lošeg podnošenja gvoždja komplijansa njegove primene se procenjuje na 50%.
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