The document discusses the overuse of the diagnosis "anemia in pregnancy" and stresses that the cause of any anemia with a hemoglobin level less than 10.5g/dl in pregnancy must be investigated and appropriately diagnosed, such as iron deficiency anemia, folate or B12 deficiency anemia, or thalassemia. It provides guidance on selectively investigating for common and treatable causes of anemia like iron deficiency, which can be confirmed by low MCV, MCHC, and MCH with low serum ferritin, and thalassemia, which may be indicated by a family history, low MCH even with normal hemoglobin, normal or high RBC count, or MCV/R

1. Anemia in pregnancy – the most overrated diagnosis in O&G SGH!!
Anemia remains the commonest medical disorder complicating a pregnancy. It is even more
prevalent in these parts of the world.
However, the management of such patients still remains sub optimal in most instances.
The diagnosis that we often get is anemia in pregnancy!! What does that mean??
Please remember that there is no such diagnosis. Although we know anemia can be
physiological in pregnancy, any haemoglobin of less then 10.5g/dl needs to be investigated.
Don’t merely label her as anemia in pregnancy!!
An example of a appropriate diagnosis will be iron deficiency anemia, folate or vit B 12
deficiency anemia, or Alpha or Beta Thalasemia.
Keeping in mind that our recourses and facilities maybe limited, a cost effective measure
would be to selectively investigate and not routinely performing a battery of anemia work
ups.
Any Hb level of less then 10.5g/dl in pregnancy must be investigated.
The commonest cause is iron deficiency anemia which will have a reduced MCV, MCHC and
MCH. In these instances, do a serum ferritin and confirm the diagnosis.
When do we need to investigate for thalassemia?
1) In patients who have a significant family history of thalassemia
2) MCH is the most important screening parameter for thalassaemia. A low MCH even
with a normal haemoglobin levels is an indication to screen for thalasemia.
3) In thalassaemic patients, RBC s are normal or high.
4) Use the Mentzer index.
MCV/RBC count < 13 favors thalassemia over iron deficiency.
This test has a high sensitivity but low specificity.
Basically in iron deficiency, the marrow can’t produce RBCs and they’re small so the
RBC count will be low along with the MCV.
In thalassemia, RBC production is preserved, though the cells are small and fragile.
So the RBC count is normal with a low MCV.
5) Iron deficiency anemia which does not respond to iron supplementations.

2. Essential pearls
1) Ferrous salts are absorbed better then ferric salts
2) Treatment should be supplemented with Vit C to increase absorption.
This can be complemented with the national guidelines.