Juliana Mohd Basuni
defined as a decrease in the amount of red blood cells
(RBCs) or the amount of hemoglobin in the blood.
Anemia". http://www.merriam-webster.com/. Retrieved 7 July 2014.
Stedman's medical dictionary (28th ed. ed.). Philadelphia: Lippincott Williams & Wilkins. 2006. p. Anemia.
It can also be defined as a lowered ability of the blood
to carry oxygen.
Hematology : clinical principles and applications (3. ed. ed.). Philadelphia: Saunders. 2007. p. 220.
Hemoglobin in red blood cells is an oxygen-carrying
protein that binds oxygen through its iron
Hemoglobin transports oxygen to most cells in the
body for the generation of energy.
When hemoglobin levels are low less oxygen
reaches the cells to support the body’s activities
Normal physiological changes
Plasma volume (50%)
Red cell mass ( 18 – 25 % depending on iron status)
Physiologic dilution which is greatest at 32 weeks
WHO definition anemia in pregnancy
Anaemia as defined by the World Health Organization as
haemoglobin levels of ≤ 11 g/dl.
UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva, World
Health Organization, 2001
HCT < 32%
1st Trimester <11.0g/L
2nd Trimester < 10.5g/L
3rd Trimester < 11.0g/L
considerably because of differences in
socioeconomic conditions, lifestyles and health-seeking
behaviors across different cultures.
Anaemia affects nearly half of all pregnant
women in the world:
52% in developing countries
23% in the developed world
UNICEF/UNU/WHO. Iron deficiency anemia: assessment, prevention, and control.
Geneva, World Health Organization, 2001
WHO Global Database on Anemia 2008
Preschool children Pregnant women Non pregnant
child bearing age
world 47% 42% 30%
malaysia 32% 38% 30%
Severity of anemia Hb concentration in
pregnant women g/dL
Mild 8 – 11 Oral haematinics or paranteral
Moderate 6.0 – 8 Depending on period of
gestation < 36 weeks
Treat with oral haematinics
or paranteral iron therapy.
If symptomatic admit to
> 36 weeks gestation
Paranteral iron in therapy.
Consider blood transfusion.
Severe < 6 Blood transfusion with 2
units packed cells.
Anaemia is one of the most prevalent nutritional
deficiency problems affecting pregnant women .
Thangaleela T, Vijayalakshmi P. Prevalence of anaemia in pregnancy. Indian J Nutr Diet
The high prevalence of iron and other micronutrient
efficiencies among women during pregnancy in
developing countries is of concern and maternal anaemia
is still a cause of considerable maternal & perinatal
morbidity and mortality
Cutner A, Bead R, Harding J. Failed response to treat anaemia in pregnancy: reasons and
evaluation. J Obstet Gynecol 1999;suppl.:S23-7
one of the world's leading causes of disability
one of the most serious global public health problems.
Iron deficiency anaemia:
Requirements in pregnancy : 900 mg
Daily iron requirement in pregnancy : 4mg
2.5 mg/day in early pregnancy
6 – 8 mg/day from 32 weeks onwards
Absorption of iron is <10%, so an average of 40
mg dietary iron is required daily
? Iron is important
vital for all living organisms because
it is essential for multiple metabolic
processes, including oxygen
transport, DNA synthesis, and
Deficiencies of iron and other micronutrients
Haemoglobinopathies are additional factors
Van den Broek NR, White SA, Neilson JP. The relationship between asymptomatic
human immunodeficiency virus infection and the prevalence and severity of anemia
in pregnant Malawian women. Am J Trop Med Hyg 1998;59:1004-7
Prevention of Anemia
Women should be encouraged to undergo
a pre-natal check up for early detection and
treatment of iron deficient anemia.
Proper spacing between two children
( contraceptions )
Having a well balanced diet rich in iron from
Regular screening for anemia.
Fortification of ready-to-eat food with iron
Avoid / Reduce smoking / alcohol
Management for IDA
Dietary advice : 10 – 15% absorption
Iron Deficiency Anemia:
Treatment: 60 mg of elemental Fe (iron) orally every 6 to 12 hours
(e.g. 2 to 4 times per day)
Prophylaxis: 60 mg of elemental Fe (iron) orally every day.
Recommended Daily Intake
Men: 8 mg elemental Fe (iron) orally once daily
Women: 18 mg elemental Fe (iron) orally once daily
Pregnant women: 27 mg elemental Fe (iron) orally once daily
Lactating women: 9 mg elemental Fe (iron) orally once daily
Parenteral & Oral Iron Products - GlobalRPh
Iron Dextran ( Imferon / Cosmofer )
0.0442 x ( Desired Hb – Current Hb ) x Weight ( kg ) + 0.26 x Weight ( kg)
Iron Sucrose ( Venofer )
Prepregnancy Weight ( kg ) x Target Hb – Current Hb ) x 0.24 + 500mg
Cosmofer can also be given in IV route
Management options : Blood
Hb < 6.0g% at 36weeks /close to delivery
Hb < 10.0g% in Placenta Praevia for elective CS
Screen anemia in pregnancy at booking
Rule out for thallasemia is necessary
Supplementation with iron
Noted the contraindications of iron therapy
Continue supplemantation through
postpartum until cessation of lactation