2. For pregnant lady
Mild 9 – 10.9 g/dl
Moderate 7.0 – 8.9 g/dl
Severe < 7.0 g/dl
Very severe < 4.0 g/dl
Anaemia: Diagnosis dan
‘severity’
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin
and Mineral Nutrition Information System. Geneva, World Health Organization, 2011
(WHO/NMH/NHD/MNM/11.1)
(http://www.who.int/vmnis/indicators/haemoglobin.pdf accessed [9 June 2013])
3. Why is anaemia an important
issue
in pregnancy
• Maternal complications
– Heart failure
– Increased susceptibility to infections
– Inability to withstand hemorrhage – main cause for
mortality in this country
– Postnatal complications
• Postpartum depression
• Insufficient milk syndrome
• Fetal complications
- Spontaneous miscarriages
– Low birth weight – IUGR/SGA
– Premature birth
– Fetal hypoxia
6. Hypochromic Microcytic Anaemia
• Causes
– Iron deficiency anaemia
• Poor dietary intake of iron
• Chronic depletion of iron stores
– Poor spacing
– Chronic bleeding – menorrhagia pre pregnancy,
hemorrhoid
– Worm infestation
– Thalassemia
• History taking should focus on these factors to
ascertain cause of anaemia
8. How to differentiate IDA &
Thalassemia?
Parameters IDA Thalassemia Normal range
MCH Low Low 27 – 31 pg
MCV Low Low 80-100 fl
Hemoglobin Low Low/ normal 12.0 – 15.5 g/dl
RBC Normal High 4.2 – 5.4 x 106/uL
RDW - CV High Low/ normal 11 – 15%
Serum ferritin Low Normal 15 – 150
TIBC High Normal 54 - 84
9. Algorithm of investigations
FBC
Hb low MCH low
Send ferritin/TIBC,
stool for ova & cyst
Start hematinics
For Hb analysis if
serum ferritin is normal
DNA Analysis if
required
If Hb does not improve,
rpt Ferritin after 3/12
11. Management of IDA
• Increase dietary intake of iron
• Heme products – better absorption
– Clams
– Beef
– Lamb
– Liver
• Non heme products
– Nuts
– Dark leafy vegetables – spinach
– Whole grains
– Tofu
12. Management of IDA
Iron supplements
Oral
Parenteral
Blood transfusion
13. WHO Recommendations for Iron
Supplements in Pregnancy
• Recommended daily intake (RDA) of iron for
pregnancy (maintenance / physiological iron
requirement) is about 30-60 mg of elemental iron.
• In settings where prevalence of anaemia is high,
it is recommended to supplement 60mg of
elemental iron rather than lower dosages.
• The oral daily dose for iron deficiency anaemia
should be 100-120 mg of elemental iron.
• Higher doses should not be given, as absorption
is saturated and side effects increased.
14. Comparison between iron supplements
Type of iron
supplement
Iron Content Elemental iron
Ferrous fumarate 200mg 65mg
Ferrous sulphate 300mg 60mg
Obimin Fe Fumarate 90mg 30mg
Iberet folic Fe Sulphate 525mg 105mg
Zincofer Fe Fumarate 350mg 115mg
Maltofer Ferric Hydroxide 100mg 100mg
- Therefore 1 tablet obimin is NOT ENOUGH for treatment of IDA in
pregnancy but can be used as a prophylactic measure to prevent the
onset of IDA.
- To achieve 100-120mg of elemental iron:
• 2 tablets ferrous fumarate = 130 mg elemental iron
• 1 tablet iberet folic = 105 mg elemental iron
• 1 tablet of zincofer = 115mg elemental iron
• 1 table of maltofer = 100mg elemental iron
15. - Must be taken correctly:
• Iron supplement should be taken on an empty
stomach, 1 hour before meals, with
• a source of vitamin C (ascorbic acid) such as
orange juice to maximise absorption.
• Other medications or antacids should not be
taken at the same time.
16. Parenteral iron (Cosmofer)
Given to patients who are not compliant to oral
hematinics.
Indication: Iron deficiency anaemia with Hb of
less than 9.5 above 28 weeks (ensure serum
ferritin is available prior to injection)
17.
18. • Observe for at least 30 mins following ench
CosmoFer inj Restart oral iron after the last
dose of CosmoFer Repeat Se Ferritin 2 weeks
after the last dose of Cosmofer Any cases
which might require parenteral iron, must be
discuss with FMS first
• Admit for blood transfusion if Hb < 8.0 or if patient
is symptomatic regardless of Hb level.
19. Management of Thalasemia
Should be on folic acid 5mg OD at least 3 months prior to
pregnancy
Se ferritin should be performed immediately at booking/
upon the diagnosis of Thalassemia
Low dose iron supplements (eg. Obimin) should be
started if serum ferritin < 50 – should be informed to FMS
prior to initiation
Should not be subjected to parenteral iron
22. • Commonest cause is B12/ folate deficiency in
pregnancy is poor dietary intake
• Food that contains high dietary content of B12/
folate are:
– Dark leafy green vegetables
– Asparagus, broccoli, cauliflower, celery, carrots
– Citrus fruits
– Beans & nuts
– Corn
WHO recommends 0.4mg of folic acid even before
conception to prevent neural tube defects, anaemia,
preterm birth, low birth weight & puerperial spesis.
27. Dilutional Anaemia
A diagnosis of exclusion
Due to physiological changes during pregnancy –
increase of plasma volume by 50%, but only 30% in
RBC mass
Usually seen in 2nd trimester – Hb concentration is
lowest between 28-34 weeks
Hb concentration usually does not fall below 10.5
gm/dl
![ For pregnant lady
Mild 9 – 10.9 g/dl
Moderate 7.0 – 8.9 g/dl
Severe < 7.0 g/dl
Very severe < 4.0 g/dl
Anaemia: Diagnosis dan
‘severity’
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin
and Mineral Nutrition Information System. Geneva, World Health Organization, 2011
(WHO/NMH/NHD/MNM/11.1)
(http://www.who.int/vmnis/indicators/haemoglobin.pdf accessed [9 June 2013])](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)