Pregnancy_Anaemia_Flashcards
When are pregnant women screened for anaemia?
At the booking visit (often done at 8-10 weeks) and at 28 weeks.
What are the NICE cut-offs to determine whether a pregnant woman should receive oral iron therapy in the first trimester?
< 110 g/L.
What are the NICE cut-offs to determine whether a pregnant woman should receive oral iron therapy in the second/third trimester?
< 105 g/L.
What are the NICE cut-offs to determine whether a postpartum woman should receive oral iron therapy?
< 100 g/L.
What is the management for anaemia in pregnancy?
Oral ferrous sulfate or ferrous fumarate. Treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished.
summarise anaemia in pregnancy
Pregnancy: anaemia
Pregnant women are screened for anaemia at:
the booking visit (often done at 8-10 weeks), and at
28 weeks
NICE use the following cut-offs to determine whether a woman should receive oral iron therapy:
Gestation Cut-off
First trimester < 110 g/L
Second/third trimester < 105 g/L
Postpartum < 100 g/L
Management
oral ferrous sulfate or ferrous fumarate
treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished
A 24-year-old woman had blood tests taken at her 10-week booking appointment with the midwife. This is her first pregnancy. She has no past medical history to note and was well at the appointment. The blood tests included a full blood count (FBC); the results of which are shown below:
Hb 107 g/L Male: (135-180)
Female: (115 - 160)
Platelets 356 109/L (150 - 400)
WBC 6.7 109/L (4.0 - 11.0)
What would be the most appropriate management based on these results?
Arrange for an intravenous (IV) iron infusion
Check serum ferritin levels
Give dietary advice to increase iron intake
Recheck FBC in four weeks time
Start oral iron replacement therapy
Start oral iron replacement therapy
A cut-off of 110 g/Lshould be used in the first trimester to determine if iron supplementation should be taken
Start oral iron replacement therapy is correct. A cut-off of 110 g/L should be used in the first trimester to determine if iron supplementation should be taken. This reduces to 105 g/L in the second trimester.
Arrange for an intravenous iron infusion is incorrect. There is no indication that IV iron replacement is required in this case. Oral supplementation should be adequate and the response to this should be reviewed.
Check serum ferritin levels is incorrect. NICE guidelines state that haemoglobin of less than 110 g/L in the first trimester should begin oral iron supplementation. While ferritin levels could be checked and are usually accurate in the first trimester; by the second and third-trimester serum ferritin levels fall independently of iron stores and are therefore unreliable.
Give dietary advice to increase iron intake is incorrect. As the patient is pregnant iron replacement therapy should be commenced. However, it can also be relevant if dietary deficiency of iron is thought to contribute to the deficiency to give dietary advice and consider dietician referral.
Recheck FBC in four weeks time is incorrect. The results show that this patient’s Hb is below the cut off for treating anaemia in pregnancy therefore iron replacement should be started. The patient will require blood tests to monitor FBC four weeks after starting treatment, however treatment shouldn’t be delayed by waiting for repeat tests.
A 35-year-old woman who gave birth two weeks ago is becoming very tired after walking to the shops and back. The birth was via a caesarean section and she required two units of blood to be transfused. She presents to her general practitioner and denies any chest pain, palpitations, shortness of breath, or further bleeding.
On examination, there are no signs of further active bleeding and the caesarean section scar is healing well.
Blood results are as follows:
Hb 93 g/L Female: (115 - 160)
Platelets 230 * 109/L (150 - 400)
WBC 6.8 * 109/L (4.0 - 11.0)
Ferritin 5 µg/L (15 - 300)
What is the haemoglobin cut-off for this patient to receive iron?
<100 g/L
<105 g/L
<110 g/L
<120 g/L
<125 g/L
<100 g/L
A cut-off of 100 g/Lshould be used in the postpartum period to determine if iron supplementation should be taken
<100 g/L is the correct answer as the cut-off to determine if iron supplementation is required for this postpartum woman. The oral iron should be continued for 3 months after the ferritin has been normalised to ensure adequate stores for haem production and efficient oxygen delivery to the tissues.
<105 g/L is incorrect as this is the cut-off for iron supplementation if this woman was in her second or third trimester of pregnancy.
<110 g/L is incorrect as this is the cut-off for iron supplementation if this woman was in her first trimester of pregnancy.
<120 g/L is incorrect as this is not a recognised cut-off for iron supplementation. However, it is up to the doctor’s discretion and guided by the patient’s symptoms whether or not to give iron for anaemia.
<125 g/L is an incorrect answer as it is not a recognised cut-off for iron to be given. However, a haemoglobin level of less than this in men would prompt further investigations of potential bleeding sources.
A 32-year-old primiparous woman who is 9 weeks pregnant. She enquires about iron supplementation. Her blood tests show:
Hb 109 g/L Male: (135-180)
Female: (115 - 160)
What haemoglobin cut-off should be used in order to commence treatment in this patient?
95
100
105
110
115
110
A cut-off of 110 g/Lshould be used in the first trimester to determine if iron supplementation should be taken
Important for meLess important
110 is the correct target for this woman as she is in her first trimester. Based on her result, she would benefit from iron supplementation.
While memorising target numbers can be a tedious process, these are a common topic in the AKT and easy to learn as they decrease by 5 units on each ‘step’:
115 for non-pregnant women, 110 in early pregnancy, 105 in later pregnancy, and 100 after childbirth.
95 is incorrect as it is not a target for haemoglobin in the first trimester, although individual Hb targets may be needed for patients with haemoglobinopathies such as sickle cell or thalassaemia.
100 is the cut-off for women in the postpartum period with uncomplicated deliveries. This woman is in the first trimester, therefore this cut-off is not the correct one for her.
105 is incorrect for this woman as she is in the first trimester of pregnancy, but it is a correct target for the second and third trimesters.
115 is the target for non-pregnant, non-postpartum women and therefore is not the correct answer in this specific case.
