Anaemia during pregnancy

Question 1

Types of anaemia during preg

Answer 1

Hb<11 during pregnancy
Hb<10.5 in T2 = anaemia (haemodilution)
Hb<10 postpartum

1. Iron def anaemia 50%
2. Megaloblastic anaemia (folate def)
3. Thalassaemia (beta)

Question 2

Mx of anaemia of preg

Answer 2

1. Hb .. low..
2. MCV, MCH, MCHC ..
3. MCV, MCH low - microcytic, hypochromic anaemia …
   mcc id Iron deficiency anaemia ..
4. Sr ferritin … low in Iron def A
   If normal, check Sr B12 folic acid
   If normal, Hb electrophoresis

Hb <8 - refer to hematology, consider IV iron in T2, T3
5. Supplements
Ferrous sulphate 0.9g OD
Folic acid 5mg BD
Thalassaemia - screen partner

Question 3

When/How do you start iron supplementation for pregnancy

Answer 3

only in anaemia cases

routine administration of iron supplements in pregnancy is not recommended in Australia

FBC normally done at first visit, 28wks

If low Hb,ferritin = iron supplementation 100mg
Recheck in 2 wks

If normal Hb, low ferritin = iron tabs 60mg
Recheck in 4wks

Question 4

Recommended folic acid and B12 during pregnancy

Answer 4

Folic acid- 0.4gms for 12wks
B12 2.6mcg throughout

Question 5

Assessment of B12

Answer 5

In:
1. vegetarian and vegan diets
2. malabsorption- Crohn’s disease and coeliac disease
3. autoimmune diseases
4. metformin
5. bariatric surgery, particularly gastric sleeve surgery

Active B12&raquo_space; total B12 measurement

Deficiency - neural tube defects