Anaemia in pregnancy

O99. 0 + (D50.9/D64.9)

DESCRIPTION

Haemoglobin (Hb) <11 g/dL. Anaemia in pregnancy is most commonly due to iron deficiency. Hb levels in pregnancy should be routinely checked on-site at the first antenatal visit, and again at 30 weeks and 38 weeks. If Hb falls below 10g/dL, commence treatment with iron and do a FBC .

LoEIII [1]

GENERAL MEASURES

A balanced diet to prevent nutritional deficiency.
Advise against eating soil, clay, charcoal, and excessive consumption of tea and coffee .

MEDICINE TREATMENT

Prophylaxis Z34.9 + (Z29.9)

  • Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) daily.

LoEIII [2]

OR

  • Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) daily .

(For folic acid supplementation guidance to prevent neural tube defects, see PHC STGs and EML Antenatal supplements) .

Iron deficiency (Hb <10g/dL)

  • Ferrous sulfate compound BPC, oral (dried), 170 mg (± 55 mg elemental iron) 12 hourly .

LoEI [3]

OR

Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly .

LoEIII [4]

    • Continue for 3–6 months after the Hb reaches normal to replenish iron stores.
    • Hb is expected to rise by at least 1.5 g/dL in two weeks.
    • When using iron together with calcium supplementation, ensure that iron and calcium are taken at least 4 hours apart from one another.
    • If Hb has not increased after 4 weeks of therapy, do a FBC to confirm hypochromic microcytic anaemia.

Parenteral iron - See Anaemia, iron deficiency.

If there is no response to oral iron, and iron deficiency is confirmed, review adherence to oral iron, and consider:

  • Iron, IV , e.g.:
    • Iron sucrose, IV, 200 mg in 200 mL sodium chloride 0.9%, over 30 minutes, given on alternate days until the total dose has been given.
      • Note: Test dose is not required, but only administer where personnel and therapies are readily available to manage anaphylactic-type reactions.
      • An initial total dose of 600 mg is usually adequate to raise the Hb to acceptable levels.
      • For markedly anaemic or very obese women, consult the package insert on the total dose of iron infusion .

LoEIII

REFERRAL/CONSULTATION

No response to management.