How to manage Anemia during pregnancy? - Dr. Sangeeta Gomes

Anemia according to WHO is hemoglobin less than 11 grams per 100 ml. What are the causes? It could be physiological in pregnancy, pathological due to iron deficiency, folic acid, B12 deficiency, protein deficiency. Hemorrhage or bleeding occurring in early pregnancy due to piles problems, fissures hookworm infestation can also add on to anemia, hereditary causes like sickle cell hemolytic anemia. Other causes could be bone marrow insufficiency, malaria, tuberculosis, leukemia. Coming to the treatment of anemia. Correct the anemia before planning for pregnancy. Keep gaps between pregnancy. In pregnancy we start the iron therapies from the 2nd trimester onwards. That is 200 mg of iron with folic acid. Add Vitamin C in the form of lime juice as it facilitates iron absorption well. Do not take milk products with iron as it can form a chelate and hinder its absorption. Treatment of anemia. Correct the hemoglobin before getting pregnant. Take protein rich diet, green leafy vegetables, liver, meat, figs, nuts,legumes, banana and fish. Hemoglobin is done at the first visitbthen at 20 weeks, 28 weeks, 30 weeks and 3 weeks of pregnancy. The choice of treatment of anemia depends on the choice of treatment of anemia and the duration of pregnancy, that is the time decided by the doctor to treat the anemia. Start with iron tablets orally, initial one per day, gradually increasing to 3 tablets per day. But there could be side effects like nausea, vomiting, diarrhea, acidity. We have to assess the patient after 3 weeks after the oral therapy, like improvement in the wellbeing, patient feeling better, increase appetite, improved outlook, increase in the Hb and the PCV. If there is failure in therapy go for intravenous therapy that is available as iron sucrose. It can be given intravenously by mixing in the normal saline. It is just an outpatient procedure. It does not need any hospitalization. There is a formula used to calculate how much iron is needed and can be given at weekly intervals and injection of B12 can be given at regular intervals to facilitate the hemoglobin rise fast. The advantage is there is faster rise of hemoglobin of 1 gram per week at 100 ml. Maximum rise is seen at the end of 4 to 8 weeks. Decision to start the iron therapy should start at 28 to 30 weeks if the woman is severely anemic. Blood transfusion is given to women only in the last trimester when they come for checkup with severe anemia. As we have no time to improve the hemoglobin as they are coming close to their delivery date.