1. Anemia is common in pregnancy, with iron deficiency being the most frequent cause affecting up to 90% of cases. 2. Iron deficiency anemia develops over stages from depletion of iron stores to a reduction in hemoglobin and impairment of oxygen carrying capacity in the blood. 3. Screening and treatment of iron deficiency anemia in pregnancy aims to prevent maternal complications during pregnancy, childbirth, and the postpartum period as well as fetal growth restriction and low birth weight. 4. Treatment involves oral or intravenous iron supplementation depending on severity, with the goals of replenishing iron stores and raising hemoglobin levels.

1. Anemia In Pregnancy
Ryan Saktika Mulyana
Pembimbing
DR. Dr. AAN Jaya Kusuma, SpOG(K), MARS

2. Pregnancy : Most dangerous journey of mankind
aggravated during
pregnancy
Anemia begins in childhood, worsens during adolescence in girls and gets aggravated during pregnancy

3. Quantitative or qualitative reduction of Hb or circulating RBC’s or both resulting
in a reduced oxygen carrying capacity of blood to organs and tissues
Woman Hct 33% or Hb 11g/dl (1st & 3rd trimester)
And Hct 32% or Hb 10.5 g/dl in (2nd trimester)
(CDC/WHO)
Gm% ICMR WHO
Mild 10 – 11 10-10.9
Moderate 7 – 10 7-9.9
Severe 4 – 7 <7
Very severe < 4

4. Anaemia in pregnancy is defined as first trimester
haemoglobin (Hb) less than 110 g/l, second/third trimester
Hb less than 105 g/l, and postpartum Hb less than 100 g/l,
in line with British Committee for Standards in Haematology
(BCSH) guidance
(RCOG,Level evidence B)

5. Common anemias in pregnancy
Physiological Acquired Genetic/Haemoglobinopathies:
Nutritional deficiency anaemias
• Iron deficiency (90%)
• Folate deficiency
• Vit. B12 deficiency
Infections
• Malaria
• Hookworm
• UTI
Hemorrhagic acute / chronic
blood loss
Bone marrow- Aplastic anemia
Renal diseases
SCD
Thalassaemias

6. Physiological anemia
• Plasma volume increase
50 % (by 34weeks) but
RBC mass only 25%
• Disproportionate increase
in plasma vol, RBC vol.and
hemoglobin mass during
pregnancy

7. • Hb = 10 gm
• RBC = 3.2 million/mm3
• PCV = 30
• Peripheral smear showing normalmorphology of RBC
with central pallor
Criteria for
physiological anaemia

8. iron requirements during pregnancy
2.5mg /day in early pregnancy
5.5mg /day from 20 -32 weeks Average 4 mg/ day
6 – 8 mg/ day after 32 weeks
Increases from 1-2mg in 1st trimester to 6-8 mg in 3rd trimester
Maternal req. of total Iron 1000mg
 500 mg : Maternal Hb. Mass expansion
300 mg : Fetus & Placenta
 200 mg : Shed through gut., urine & skin

9. Absorption of iron depends upon
• Amount of iron in the diet
• Bioavailability of iron
• Physiological requirements
Iron sources
are two types
Haem iron (5%) : hemoglobin and myoglobin from
red meat, poultry and fish
Non haem iron (95%): fibers, green vegetables

10. Normalironcycle
Dietary iron
Utilization Utilization
Duodenum
(average, 1 - 2 mg
per day)
Muscle
(myoglobin)
(300 mg)
Liver
(1,000 mg)
Bone
marrow
(300 mg)Circulating
erythrocytes
(hemoglobin)
(1,800 mg)
Reticuloendothelial
macrophages
(600 mg)
Sloughed mucosal cells
Desquamation/Menstruation
Other blood loss
(average, 1 - 2 mg per day)
Plasma
transferrin
(3 mg)
Iron loss
Storage
iron
(Ferritin)
(TIBC)

11. Factors that modify iron absorption
Physical State Heme>Fe2+>Fe3+
High Gastric pH
Vagotomy, pernicious anemia
H2 receptor blockers, calcium-basedantacids
Intestinal Structure
disruption
Crohn’s disease, Celiac disease
Inhibitors Phytates, tannins
Competitors Cobalt, Lead, Strontium
Facilitators
Ascorbate, Citrate, Amino acids, Iron
deficiency

12. ANTEPARTUM
Effects of anaemia
in pregnancy
INTRAPARTUM POSTPARTUM
a) Pre eclampsia
b) Intercurrent infection
c) Cardiac failure
d) Preterm labour
e) APH
f) PIH
a) PPH
b) Cardiac failure
c) Shock
a) Puerperal sepsis
b) Subinvolution
c) Failing lactation
d) Puerperal venous
thrombosis
e) Pulmonary embolism

13. a) IUGR
b) Prematurity
c) Increased risk of IDA early infancy
d) Still births
e) Congenital malformations
f) ↑ in Neonatal deaths/Perinatal mortality
g) Intra uterine deaths(severe maternal
anoxemia)
h) Abnormal Social and Emotional behaviour
Effects of anaemia
in pregnancy

14. Stages of iron deficiency
Prelatent (Depletion) :
•Stores are depleted without a change in hematocrit or serum iron levels .
•Reduced stored iron e.g. Serum ferritin with normal hemoglobin
Latent (iron deficient erythropoisis) :
•Serum iron drops and the TIBC increases without a change in the hematocrit.
•Reduced stored and transport iron
•Increased erythrocyte protoporphyrin concentration
•Detected by a routine check of the transferrin saturation (normally 20-50%) IDA (<10%)

15. Clinical features
SYMPTOMS
• Fatigue
• Weakness
• Headache
• Loss of appetite
• Dysphagia
• Palpitations
• Dyspnea on exertion
• Ankle swelling
• Paresthesia
• Leukoplakia
• Cold intolerance
• irritability
SIGNS
• Glossitis
• Stomatitis
• Heart murmurs
• Increased JVP
• Tachycardia
• Tachypnea
• Postural hypotension
• Pallor
• Dryness or roughness of the skin
• Koilonychia
• Dry & cracked lips & Brittle hair

16. Diagnosis of Ida
• Low hemoglobin
• Low serum ferritin<15 mcg/dl
• Microcytic & hypochromic in absence of chronic
diseases/hemoglobinopathies
• Low serum iron content(< 30mcg/dL)
• Low PCV, MCV, MCH, MCHC
• High TIBC > 400 mcg/dl
• Increased ZPP (>40 mmol/mole heme)
• Low transferrin saturation(<15 )
• Increased serum transferrin(>350mg/dL)
• Increased serum soluble transferrin binding receptors(> 8 mg/L)
• increased serum neopterin concentration

18. Investigations

19. Iron supplements

21. Iron and folate supplementation should be
considered in all women of childbearing age in
areas of high prevalence of iron-deficiency anemia
(HRP)
Prepregnancy

22. Prenatal
Prophylactic iron supplementation
According to the Cochrane Database, routine
supplementation with iron or iron and folate does
prevent low maternal hemoglobin at delivery, but there
is very little information regarding pregnancy outcomes
for mother or baby
excess iron can result in the production of free radicals
and oxidative damage

23. Treatment
Oral iron should be the preferred first-line treatment for iron deficiency.
(RCOG,Level evidence A)
Parenteral iron is indicated when oral iron is not tolerated or absorbed or patient
compliance is in doubt or if the woman is approaching term and there is insufficient
time for oral supplementation to be effective
(RCOG, Level evidence C)
For normocytic or microcytic anaemia, a trial of oral iron should be considered as the
first step and further tests should be undertaken if there is no demonstrable rise in Hb
at 2 weeks and compliance has been checked.
(RCOG, GPP)

24. A serum ferritin level less than 50 µg/L in early pregnancy is an indication for iron
supplements
WHO recommends universal oral iron
supplementation with 60 mg of elemental iron daily
for 6 months in pregnancy in areaswhere the
prevalence of iron deficiency is less than 40%. In
areas where the prevalence is greater than 40%, the
recommendation is to continue supplementation for
3 months postpartum
The CDC recommends supplementation
with 30 mg of elemental iron daily, as
does the American College of
Obstetricians and Gynecologists
the decision to choose universal or selective prophylaxis depends on the prevalence of iron
deficiency in the obstetric population served, along with nutritional, economic, and social
factors

25. Dietary iron has two forms,
heme and non-heme iron.
Heme iron is the most
bioavailable form of iron in the
diet and comes from food
containing heme molecules,
essentially animal meat, viscera,
and blood.
Nonheme iron is obtained from cereals,
vegetables, milk, and eggs. Absorption
of nonheme iron is enhanced by ascorbic acid,
proteins, and heme and inhibited by phytates,
tea, coffee, and calcium.
Many countries now fortify food products with
iron compounds

26. Prophylaxis of iron deficiency
oral iron Various iron salts
1. ferrous fumarate
2. gluconate,
3. sulfate,
4. and succinate).
Compound preparations
with folic acid are available,
as are modified-release
preparations, which release
iron into the gastrointestinal
tract slowly
intramuscular
iron dextran
nonindustrialized
countries,
intermittent
intramuscular
iron dextran
injections are used
to ensure
compliance and
maintenance of
adequate iron
stores

27. MANAGEMENT OF IRON DEFICIENCY
The oral dose of elemental iron required to
treat iron deficiency is 100 to 200 mg daily
Ferrous sulfate 200 mg three times daily is
equivalent to 195 mg of elemental iron daily
Treatment doses of iron should continue until
hemoglobin normalizes and should be followed with
prophylactic or maintenance doses until 3 months
postpartum to ensure that iron stores are replenished.

28. The response to treatment
doses of elemental iron is rapid
1. Reticulocyte counts
increase within 5 to 10 days
of initiation
2. hemoglobin should rise 0.8
g/dL/wk
If no clinical or hematologic
response is seen after 3 to 4
weeks of oral iron therapy,
diagnostic reevaluation is
required
Evaluated
1. Ongoing blood loss,
2. concomitant infection,
3. Additional
4. hematinic deficiency,
5. noncompliance, and
6. other causes of anemia.

29. Parenteral iron therapy can be administered
intravenously as an infusion or injection and also
intramuscularly. It has no advantage over oral therapy if
oral iron is well tolerated and absorbed. IIa/B
The response rate to parenteral iron is similar
to that with oral preparations
Parenteral forms of iron include iron
dextran, iron sucrose, and ferric carboxymaltose.

30. Algorithm of suggested approach to diagnosis and management of iron-deficiency anemia in pregnancy. **Oral iron treatment
should not be interrupted once normal Hb values are achieved, but rather supplementation should continue to replenish iron
stores (gene...
Maureen M. Achebe, and Anat
Gafter-Gvili Blood
2017;129:940-949

32. IM ROUTE
Iron Dextran
(1ml contains 50mg elemental iron & 1amp=2ml)
Dose : 100 mg IM OD/AD till the total dose over
Drawbacks:
• Painful injection (less with jactofer).
• Skin discoloration
• Local abscess
• Allergic reaction
• Fe over load.
• Category C drug
• Gluteal sarcoma
• Test dose needed
Advantage
• Can be given in primary care set up
• Absolute reticulocyte count increases in 7
days
• Hemoglobin increases within 1-2 wks
• Whole dose can be given in single setting

33. Preparations of iron sucrose complex contain
20 mg/mL of iron and are used in pregnancy as
5- to 10-mL aliquots up to three times per
week in the second and third trimesters
• Commonly used in chronic kidney diseases
• MW 34,000-60,000 D
• Iron hydroxide sucrose complex in water
• Given as IV injection/infusion
• Each ml contains 20 mg of Fe
• After IV administration it dissociates into
iron & sucrose
• T 1/2 is6hrs
• Category B drug

34. Total iron deficit = Body weight x (Target Hb – Actual Hb) x 2.4 + Iron stores [mg]
• Administered 100 mg IV over 5 minutes, thrice weekly until 1000 mg
• 200mg max dose per Sitting
• Rate of administration should not more than 20 mg/min
• Infusion : 50 mg to be injected slowly over 2 minutes, wait for 2-3 min , then give
another 50 mg over 2 min
• 100mg-200 mg to be diluted with 100ml NS, infuse at least 15 min
• Marked increase in reticulocyte count expected in 7-14 days

35. Advantages of IRON SUCROSE over others
a) All iron preparations were capable of causing tissue peroxidation except iron sucrose
b) Less oxidative injury
c) Less risk of tissue parenchymal injury by free iron.
d) Higher availability for erythropoiesis than iron Dextran
e) IV iron supplementation increases the erythropoiesis 5 times
f) Safe in dextran sensitive patients
g) Minimal side effects
h) The Hb rise will be evident in as early as 5 days
i) IV iron sucrose is safe & effective
j) Iron sucrose is given both bolus push & infusion
Disadvantage
a) Total dose administered in multiple infusions
b) Needs a set up where anaphylactic reaction can be managed.

37. FERRIC GLUCONATE COMPLEX IN SUCROSE
1) Given as IV injection/infusion
2) Standard dose of 125 mg may be given
IV injection over 10 min
3) Rate should be < 12.5mg/min
4) Dose can be repeated if ferritin <
100ng/ml or saturation < 20
5) Can be safely given to Dextran sensitive
patients

38. INJECTAFER Ferric carboxymaltose is a new
compound that is now available, although
there are little human data on pregnancy
effects. It does not require a test dose to be
administered and
can be given by bolus intravenous injection or
a fast intravenous infusion.
NEWEST FAST ACTING
IV MOLECULES
Iron III Carboxymaltose
(FERRINJECT) :
of 1000 mg over 15 minutes
(maximum 15mg/kg by injection or
20 mg/kg by infusion)

39. IRON III ISOMALTOSE(MONOFER)
• Strongly bound iron in spheroid iron-carbohydrate
particle providing slow release of bioavailale iron to iron
binding proteins
• Rapidly up taken by RES and little risk of free iron for
tissue damage
• Dose : 1000 mg in a single infusion
• Erythropoietic response seen within days
• Serum ferritin returns to normal by 3 wks

40. FERUMOXYTOL
• USA FDA approved this drug in 2009 for iron
replacement in patients with IDA & CKD
• No test dose required
• Can be given as large dose (510 mg/vial) in <20
Seconds in single settings
• No significant side effects
• Not approved in Europe

42. Blood transfusions are rarely indicated in
pregnant women with iron-deficiency anemia
If a woman has severe anemia beyond 36
weeks’ gestation and there is not time to
achieve a reasonable hemoglobin
concentration before delivery, blood
transfusion should be considered.

43. BLOOD TRANSFUSION
Decision based on
• Needs and risk of developing complications of inadequate
oxygenation
• Both clinical and hematological grounds
Indications
a) Severe anemia, especially after 36 weeks
b) Risk of further hemorrhage
c) Associated infections
d) Imminent cardiac compromise

44. Recombinant human erythropoietin has also
been used in difficult cases.

45. Labor and Delivery
There are no specific recommendations for the
management of iron-deficient patients during
labor.
Consider blood transfusion in patients with
severe symptomatic anemia close to
delivery. (GPP)

46. Management during labour
• Consideration for delivery in well equipped hospital.
• Avoid sympathetic stimulation and hyperventilation; prevent rightward shift of
ODC.
• Supplemented with oxygen therapy
• Prophylactic forceps/Vaccum to cut short 2nd stage
• Decreased blood loss by active management of 3rd stage of labors.
• Avoid maternal stress, patient can go into CHF.
• PPH should be emergently treated(uterotonics)

47. Postnatal
Any women who have clear evidence of iron-
deficiency anemia should continue oral
supplementation for at least 3 months.

48. Taking iron tablets
• Absorption helped by vitamin-C (take the
tablets with glass of orange juice)
• Take before or after 1 hr of meal
• Don't take tea/coffee/milk
• Calcium based antacids will reduce the
absorption

49. ORAL IRON THERAPY
WHO : 60 mg elemental iron + 250 ug FA OD/BD.
Drawbacks:
• Intolerance
• Unpredictable absorption rate.
• Not suitable for patients with GI diseases/ significant bleeding
• Non Compliant patient.
• Long time for improvement

50. a) Failure to oral iron therapy.
b) Non compliance/intolerance to oral iron
c) 1st time seen during last 8-10 wks with severe
anemia
d) Malabsorbtion/IBD
e) Small bowel resection
f) When hemorrhage is likely to continue
g) C/I to blood transfusion
h) Combination with recombinant human
erythropoietin
i) C/I to oral therapy
Indication
Parentral therapy
a) h/o anaphylaxis to parenteral iron
therapy
b) 1st trimester ofpregnancy
c) Active acute/chronic infection
d) Chronic liver diseases
ContraIndication
Parentral therapy

51. Advantages:
a) Certainty of admission.
b) Hb rises @1gm/wk.
Disadvantage
a) Nausea and Vomiting
b) Metallic taste on tongue

52. Intravenous preparation
Iron dextran (Imferon)
Iron sucrose
Sodium ferric gluconate (ferrlecit)
Iron dextran: 50 mg/mL. Iron sucrose: 20 mg/mL. Ferric gluconate:
12.5 mg/mL
Intramuscular preparation
Iron Sorbitol Citrate in dextrin(Jectofer)
Iron Dextran (imferon)

53. MEGALOBLASTIC ANAEMIA
•Incidence – 0.2 – 5%
•Caused by folic acid deficiency & Vit B12 deficiency
Pathophysiology
• Preg. Causes 20 -30 fold increase in Folate requirement (150- 450
microgram / day ) to meet needs of fetus & placenta.
• Placenta transports folate actively to fetus even if the mother is deficient.
• Vit.B12 deficiency : Occurs in patients with gastrectomy , ileitis, ileal
resection, pernicious anaemia, intestinal parasites

54. Current WHO recommendations advise folic
acid intake of 400 µg daily with 60 mg of iron
for 6 months during pregnancy and continuing
for 3 months postpartum in areas of the world
with poor nutrition.

55. FOLATE DEFICIENCY ANAEMIA
 Folic acid reduced to DHFA then THFA, used in nucleic acid
synthesis, is required for cell growth & division.
 So more active tissue reproduction & growth more
dependant on supply of folic acid.
 So bone marrow and epithelial lining are therefore at
particular risk.
 Coexists with IDA

56. Folic acid deficiency more likely if
•Woman taking anticonvulsants.
•Multiple pregnancy.
•Hemolytic anemia, thalassemia & cleft palate
Diagnosis :
-Increased MCV ( > 100 fl)
-Peripheral smear :
• Macrocytosis, hypochromia
• Hypersegmented neutrophils (> 5 lobes)
• Neutropenia
• Thrombocytopenia
-Low Serum folate level.(<3ng/ ml)
-Low RBC folate (<20 ng/ml)

57. CLINICAL FEATURES
• Insidious onset, mostly in last trimester
• Anorexia and occasional diarrhea
• Pallor of varying degree
• Ulceration in mouth and tongue
• Glossitis
• Enlarged liver and spleen
• Hemorrhagic patches under the skin and conjunctiva
• Macrocytic Megaloblastic Anemia
• Peripheral neuropathy
• Subacute combined degeneration of the Spinal cord

58. a) Hb < 10gm
b) Hypersegmentation of neutrophils
c) Megaloblast, Howell-Jolly bodies
d) MCV > 100 fl
e) MCH > 33pg, but MCHC is Normal
f) Serum Fe is Normal or high, TIBC is low
g) Serum Vit B12 levels < 100 pg /ml
h) Radio active Vit B12 absorption test (Schilling Test)
DIAGNO
SIS

59. Management Options
Prepregnancy
Women who are contemplating pregnancy should
be advised to take folate supplements of 400 µg
daily
Use of folic acid periconceptually reduces the risk
of neural tube defects (Ia/A)

60. Prenatal
PROPHYLAXIS
Folate should be given in combination with iron supplements.
The folic acid content must be approximately 200 to 300 µg daily.
MANAGEMENT OF ESTABLISHED FOLATE DEFICIENCY
If the diagnosis is made prenatally, initial treatment is with
folic acid, 5 mg once daily, continued for several weeks postpartum
Give parenteral folate therapy if deficiency is severe. (GPP)

61. Labor and Delivery
There are no specific management recommendations for
folate-associated anemia during labor and delivery, as long as
the patient is hemodynamically stable and blood replacement
therapy is available, if needed.
Postnatal
A folate content of 5 µg/100 mL in human milk and a
yield of 500 mL daily implies a loss of 25 µg of folate
daily in breast milk

62. HAEMOGLOBINPATHIES
Sickle cell disease
a) Sickle cell anaemia (most common & severe)
b) Sickle cell beta thalassemia
c) Haemoglobin SC disease
Thalassemia
a) Alpha thalassaemia.
b) Beta thalassaemia: (Major, Minor)

63. SICKLE CELL ANAEMIA
• Valine substituted for glutamic acid at 6th position on β chain of Hb molecule
• Common variants - SS ( sickle cell anemia)
- SA ( sickle cell trait)
Hb SS Hb SA
Cell trait Homozygous Heterozygous
HbS 70 – 90%, rest HbF 10 – 40%, 40-60 HbA
Hb (g/dl) 6 - 9 13 -15
Life expectancy 30 yrs normal
Propensity for
sickling
++++ + (O2 falls< 40%)

65. SIGNS & SYMTOMS
Vaso-occlusive
complicationsA. Painful episodes-most common(50%)
B. Acute chest syndrome (20 %)
C. Strokes
D. Renal insufficiency
E. Splenic sequestration
F. Proliferative retinopathy
G. Priapism
H. Spontaneous abortion
I. Bone pains, leg ulcers,
J. Osteonecrosis

66. Complications related to hemolysis
a) Anemia (Hct 15 – 30%)
b) Cholelithiasis
c) Acute aplastic episodes Infectious
complications
• Streptococcus pneumonia sepsis
• E.coli sepsis
• Osteomyelitis
DIAGNOSIS
• Hb solubility test-specific, cheap, rapid and
simple.
• Sickling test

67. Hb
electrophores
is

68. Hemoglobin electrophoresis screening of the entire population
or high risk groups (Ia/A)
Screen partner; if the result is positive, consider counseling
and prenatal diagnosis (Ia/A)
Folic Acid 5mg daily should be given (GPP)
Hydroxurea if taking should be stopped 3 months prior
conception
ACE inhibitors & angiotensin receptor blockers stopped before
conception
Early detection and treatment of malaria and infections
Low dose Aspirin from 12 wks of gestation
Prenatal

69. • Thromboprophylaxis with LMWH (GPP)
• NSAIDS between 12 to 28 weeks
• Fluid and oxygen therapy(oxygen saturation > 95%) in
painful crisis
• BT indicated only during complications like acute
anemia/ACS/twin pregnancies, preeclampsia, septicemia,
renal failure (GPP)
• Goals : Hb > 8gm/dl & HbA > 40% of total Hb
• Iron therapyto be given if there is evidence of iron deficieny
• Vaccine : H influenza type b, conjugated menigococcal C
vaccine, peneumococcal vaccine & Hepatitis-B vaccine

70. • Timing of deliver : 38-40 wks of gestation either
by induction of labour/elective CS
• Factors to be avoided favouring sickling (GPP)
- Dehydration
- Hypotension
- Hypothermia
- Acidosis
- High conc. of HbS
Labor and Delivery

71.  CS is preferred over vaginal delivery when labour is
not progressing well.
 Continuous FHR monitoring due to increases rate of
still births/abruption/compromosed placental
reserve
 Counseling the parents regarding partner screening
for carrier detection.
 Contraceptives (GPP)
a) Porgesterone only pill
b) Injectable contraceptives
c) LNG-IUS
d) Barrier methods
e) Sterilization

72. THALASSAEMIAS
• The synthesis of globin chain is partially or completely
suppressed resulting in reduced Hb. content in red
cells,which then have shortened life span.
• TYPES:
- Alpha thalassaemia.
- Beta thalassaemia: Major & Minor
• Microcytic haemolytic anaemias
• Reduced synthesis of one or more of polypeptide globin
chains.
• Higher transfusion requirements in pregnancy worsen
haemosiderosis & cardiac failure.

80. CLINICAL FEATURES
• Usually asymptomatic
• Weakness, fatigue, exhaustion, loss of ppetite, indigestion,
giddiness, breathlessness
• Palpitations, tachycardia, breathlessness, increased cardiac output,
cardiac failure, generalised anasarca, pulmonary edema
a) Pallor
b) Nail changes
c) Cheilosis, Glossitis, Stomatitis
d) Edema
e) Hyperdynamic circulation (short & soft systolic murmur)
f) Fine crepitations

81. TREATMENT
• Women with hemoglobinopathy should be offered
oral iron therapy if serum ferritin<30 mcg/L
 Referral to secondary/tertiary care to be done if
a) Severe anemia
b) Significant symptoms
c) Late gestation(34 wks)
d) Failure to respond to oral iron

82.  WHO - 60 mg Elemental iron + 400 micro gram
Folic acid / day up to 3 months postpartum
 GOI - 60 mg elemental Iron + 500 mcg Folic acid as
Prophylactic supplementation x 100 days in 2nd
trimester up to 3 months postpartum

83. ANAEMIA ASSOC. WITH CHRONIC INFECTIONS / DISEASE
• Common in developing countries
• Poor response to Haematinics unless primary cause is
treated
• Worm infestigation is common ( Diagnosed by stool
examination )
• Urinary tract inf, & asymptomatic bacteriuria in preg. is
assoc. with refractory anaemia
• Chronic renal disorders = due to erythropoietin def.

84. TREATMENT
• Identifying the etiology and treat accordingly
• Deworming with mebendazole/albendazole/levamisole
• Treated with recombinant Erythropoietin for renal
disease.
• ATT to a patients with tuberculosis
• Antibiotics to treat UTI according to sensitivity

85. PREVENTION
• Dietary advice and modification(red meat/ poultry/fish)
• Germination and fermentation of cereals and legumes
improve the bioavailability of iron in food
• Green peas/Whole wheat/Green vegetables/Jaggery
• Iron supplementation of adolescent girls & non pregnant
women
• A nutritious diet in a pregnant woman should be
providing about 40 mg elemental iron daily.

86. • Food fortification
a) Fortification of staple food like wheat
flour which is technically simple(USA)
b) Fortification of curry powder, salt and
sugar, dried and liquid milk(SA)
c) Fortification of infant foods (INDIA)
d) Fortification of complimentary foods
(USA)

87. TERIMA KASIH