Iron Deficiency Anemia during Pregnancy:
(The most important points)
Iron Deficiency Anemia Diagnosis:
– Hb <11 gm/dL, decreased MCV & MCHC (mean corpuscular Hb conc.)>>> Microcytic hypochromic anemia.
– Decreased s. iron, s. ferritin & increased total iron-binding capacity (TIBC)>>> diagnostic of iron deficiency anemia.
Iron Deficiency Anemia Management:
– Regardless of anemia status, daily oral supplementation with 30-60 mg of “elemental iron” & 400 μg of folic acid is recommended.
– Ferrous sulfate is the most commonly used.
– There are 2 types of tablets: 325 mg OR 195 mg tab. (contain 65 mg OR 39 mg of elemental iron, respectively) & given 1-3 times daily.
– A dose of 200-300 mg of elemental iron/day should result in the absorption of up to 50 mg iron/day.
– Ferrous fumarate & gluconate are absorbed better than ferrous sulfate & have less morbidity dt. less elemental iron content.
– The indicator of successful therapy: 2 gm/dL increase in the Hb level in 3 wk.
– Duration: it should be continued for about 2 months after correction of the anemia to refill body stores with iron.
– Iron dextran (CosmoFer®):
* 1 amp. (2 ml) contain 50 mg/ml (total 100 mg/amp) given IM or IV.
* Test dose (25 mg or ½ ml) is given initially to test for hypersensitivity.
* If large doses are to be given (>100 mg/1 amp.), it should be diluted in NS solution & infused over a 60-90 minutes.
– Iron sucrose (Venofer®):
* 1 amp. (5 ml) contain elemental iron 20 mg/ml (total 100 mg/amp) given IV.
* It is safer than iron dextran & can be given to patients hypersensitive to iron dextran.
* Given max. 3 times/wk.
– Volume of product required (ml) = [Wt. (kg) X (Target Hb ‒ Actual Hb) X 2.145] /C (Where C =conc. of elemental iron (mg/ml) in the product being used)
e.g. if we have patient 75 kg & her Hb now 7 & we want to make it 14, this is our equation>>> [75 x (14-7) x 2.145]>>> iron deficit is 1126 mg> /20 mg (if we will use iron sucrose) = 56 ml>> /5 ml (the volume in 1 ampule Venofer) =11 amp. iron sucrose (Venofer).
– For iron dextran (CosmoFer), you can give a total dose infusion of 1000 mg (10 ampules) in 250 mL of normal saline over ONE hour. Although this is not FDA-approved dosing, but was tried in >5000 administrations without complications.
– A test dose is required first (0.5 mL [25 mg]). We prefer to administer the test dose over 5 minutes while observing the patient. If no symptoms occur during the first 5-10 minutes, it is extremely unlikely that an infusion reaction will occur. After the test dose, we administer the remainder of a 1000 mg dose over one hour.
– Take care this single large dose is applicable only for low molecular weight Iron dextran (CosmoFer) & Ferumoxytol (Feraheme) & neither for Ferric gluconate nor Iron sucrose (Venofer).
– Number of adverse events attributed to IV iron are in fact due to premedications (using Avil & dexamethasone in the solution from the start without allergic reactions) . So, we do not give any premedications to patients without a history of asthma or more than one drug allergy.
– For Iron sucrose (Venofer), we give it over multiple doses of 200-300 mg (2-3 ampules) at once in one solution & max. 3 times/wk without any need for a test dose.
– Indication for transfusion: if Hb <7-8 gm/dL.
– Transfusions is rarely indicated unless there is hypovolemia from blood loss OR an operative delivery must be performed on a patient with anemia.
Monitoring of treatment:
– For patients receiving oral iron, we often re-evaluate the patient 2 wk after starting.
– For IV iron, we generally see patients 4-8 weeks after the iron has been administered. We do not obtain repeat iron parameters for at least 4 weeks, because IV iron interferes with most assays of iron status.
Iron Deficiency Anemia Videos:
Iron Deficiency Anemia in Pregnancy -M. Ali Parsa, M.D.
Iron deficiency anemia is the most common cause of anemia in pregnancy. Most women have inadequate iron stores secondary to menstrual blood loss, recent pregnancies and lactation. In a typical singleton gestation, the maternal need for iron averages close to 1000 mg, which exceeds the iron stores of most women. By M. Ali Parsa, M.D., Southern Ocean Medical Center Obstetrician/Gynecologist
“Anemia in Pregnancy,” Robert Means Jr. , M. D .
Iron Deficiency Anemia PowerPoint presentations:
Guidelines on management of iron deficiency in pregnancy British Committee for Standards in Haematology 2012. Aboubakr Elnashar, Egypt Aboubakr Elnashar
Prof. M.C.Bansal. MBBS., MD. MICOG. FICOG. Founder Principal And ControllerJhalawar Medical college & Hospital Jhalwar. Ex Principal & controller MGMC & Hospital Sitapura ,Jaipur.
Iron Deficiency Anemia during pregnancy
Iron Deficiency Anaemia During Pregnancy Dr. Mamdouh Sabry MD. Ain Shams, Ph.D. France Consultant Ob. & Gyn. EL Mataria Teaching Hospital, Nasser Institute Cairo, Egypt.
Iron Deficiency Anemia during Pregnancy