8.13 Anaemia in Pregnancy

Question 1

When are women routinely screened for anaemia in pregnancy?

Answer 1

• booking clinic

- 28 weeks gestation

Question 2

When are pregnant women screened for haemoglobinopathies?

Answer 2

• booking clinic all are offered thalassaemia and high risk women are offered sickle cell.

Question 3

Why can anaemia be normal in pregnancy?

Answer 3

Plasma volume increases so there is relative dilution of haemoglobin.

Question 4

How might MCV point towards the possible cause of anaemia?

Answer 4

low MCV - iron deficiency

normal MCV - physiological (high plasma volume)

large MCV - B12 or folate deficiency

Question 5

What is the normal Hb in non-pregnant women?

Answer 5

120 - 150 g/L

Question 6

What are the normal Hb levels during pregnancy?

Answer 6

> 110 g/L at booking bloods

> 105 g/L at 28 weeks

> 100 g/L post partum

Question 7

What does a low ferritin indicate?

Answer 7

low iron stores

Question 8

What are iron-deficient anaemic pregnant women offered?

Answer 8

anaemic –> ferrous sulphate 200mg TDS

just low ferritin –> iron supplements

Question 9

Symptoms of anaemia?

Answer 9

• SOB
• fatigue
• dizziness
• pallor

Question 10

If a pregnant women is low in B12 what should you check?

Answer 10

Check for pernicious anaemia by looking for intrinsic factor antibodies.

(increased plasma volume and more B12 requirement are likely cause)

Question 11

What treatment options does a haematologist have for treating low B12 in pregnancy?

Answer 11

• IM hydroxycobalamin

- PO cyanocobalamin

Question 12

Pregnant women should be taking 400 micrograms of folate OD, what should this be increased to if deficient?

Answer 12

5mg daily