Overview

• Pregnant women with Hb <110g/L.
  • First Trimester <110g/L, Second/Third Trimester <105g/L, Postpartum <100g/L → CUT OFFS FOR ORAL IRON THERAPY.
• Women are screened for anaemia twice during pregnancy → booking clinic and 28 weeks gestation.
  • Also 20-24 weeks if multiple pregnancy (three times total).
• During pregnancy, plasma volume increases → causes a reduction in haemoglobin concentration.
• Thalassaemia ⇒
• Sickle Cell ⇒

Making Diagnosis

Clinical Features

• SOB, fatigue, dizziness, pallor.

Investigations

• Mean Cell Volume ⇒
  • Low → iron deficiency.
  • Normal → physiological anaemia due to increased plasma volume in preganncy.
  • Raised → B12 or folate deficiency.

Management Plan

• Iron → oral ferrous suphate 200mg three times daily.

  • Repeat FBC in 2 weeks to assess response.
  • Treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished.

• B12 → IM hydroxocobalamin injections or oral cyanocobalamin tablets.

• Folate → all women should already be taking folic acid 400mcg daily. Women with folate deficiency are started on folic acid 5mg daily.

  • Indications for 5mg Folic Acid → metabolic diseases (diabetes, coeliac), obesity (BMI >30), personal or family history of neural tube defects, on anti-epileptics, haemaglobinopathies.

    <aside> 💡 MORE(H) → metabolic diseases (diabetes, coeliac), obestiy (BMI >30), relative or personal history of neural tube defects, epilepsy (on anti-epileptics), haemaglobinopathies.

    </aside>

• Intrapartum ⇒

  • Deliver on labour ward.
  • IV access and G&S on admission.
  • Active management of 3rd stage to prevent PPH.