Uk. GuideLines Flashcards by Siba Kherbek

What is the prevalence of iron deficiency globally?

2 billion people

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What is the definition of anaemia in pregnancy?

< 110 g/L in the first trimester
< 105 g/L in 2nd & 3rd trimester
< 100 g/L in postpartum period

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When CBC should be assessed in normal pregnancy?

At booking
At 28 weeks

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Is routine iron supplementation recommended for all women in pregnancy in UK?

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What is the first line diagnostic test for anaemic pregnant women?

A trial of oral iron
An increment demonstrated at 2 weeks is a positive result

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When to check ferritin in non anaemic pregnant women who are identified to be at increased risk of iron deficiency?

Early in pregnancy
Offer iron supplements if ferritin < 30 mg /L

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What is the dose of iron supplements in women with iron deficiency anemia?

100 - 200 mg / daily of elemental iron

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When to consider referral anaemic women to secondary care ?

1- significant symptoms
2- severe anaemia ( Hb < 70)
3- late gestation ( > 34 weeks)
4- there is a failure to respond to a trail of oral iron ( no rise in Hb at 2 weeks)
❤🌷the starting dose should be 200 mg of elemental iron daily 🌷❤

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What cautions should be taken if nausea and epigastric discomfort happened?

❤ preparation with lower iron content should be tried

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What is the period of time that iron supplementation should be continued after Hb is in normal range?

For 3 months and at least 6 weeks postpartum

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What is the iron dose In non anaemic pregnant women with iron deficiency ?

65 mg / daily
Repeat Hb / ferritin after 8 weeks

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What is the iron dose for women with Hb < 100g / L in the postpartum period?

❤ 100-200 mg / daily for 3 months
🔴 check Hb & ferritin at the end of the therapy

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When to consider parenteral iron in women with confirmed iron deficiency?

fail to respond to oral iron
intolerant of oral iron
proven malabsorption

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What is the definition of :
Iron depletion/ iron deficiency?

❤ Iron depletion: ⬇️ ferritin
Normal transport & functional iron
No iron to mobilize if the body needs more iron
❤ iron deficiency: ⬇️ ferritin
⬇️ transport iron (⬇️ transferrin)
⬇️ Hb

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What is the prevalence of iron deficiency anemia in pregnancy?

30- 40 %

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What are the maternal effects of iron deficiency anemia?

1- severe infections
2- poor work capacity
3- disturbances in postpartum cognition and emotions

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What is the Hb threshold below which maternal mortality increases?

8.9 g / dl
Associated with doubling of maternal death

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What are the fetal effects of iron deficiency anemia?

Fetus is protected by upregulation of placental iron transport protein

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What is the effect of iron deficiency anemia on pregnancy outcomes?

1- preterm delivery
2- low birth weight
3- placental abruption
4- peripartum blood loss

What are the clinical symptoms of iron deficiency anemia?

1- Fatige ( most common symptom)
2- pallor / weakness / dizziness
3- headache/ palpitations
4- dyspnoea
5- pica ( ice - dirt )
6- feeling cold

What are the symptoms of iron deficiency that may occur even without anaemia?

1- fatigue
2- irritability
3- poor concentration
4- hair loss

What are the laboratory tests findings in iron deficiency anemia?

1- CBC: ⬇️ Hb / ⬇️ MCV / ⬇️ MCH
2- Blood film : microcytic hypochromic red cells ( pencil cells)
3- ⬇️ ferritin
4- ⬆️ ZPP ( Zn protoporphyrin)
5- ⬆️ sTfR ( soluble transferrin receptor )
6- ⬇️ reticulocyte number

What is the first laboratory test to become abnormal as iron stores decrease?

Serum ferritin
Not affected by recent iron ingestion

How serum ferritin concentrations varies during pregnancy?

initially rises
fall by 32 weeks (to about 50 % prepregnancy levels)
mildly increase in 3rd trimester.

What is the ferritin concentration that is diagnostic of established iron deficiency in pregnancy? When to treat?

< 15 mg / L Treatment should be prompt in pregnancy if : Ferritin < 30 mg / L

Why are (serum fe / TCBI / transferrin ) unreliable indicators of iron depletion?

Because of wide fluctuation in levels due to 1- recent ingestion of Fe 2- diurnal rythm 3- infection

What is the gold standard for assessment of iron stores?

Bone marrow sample stained for iron

In a trail of iron therapy when to check Hb ?

After 2 weeks A rise confirms iron deficiency Hb should rise by 20 g/L over 3-4 weeks

In anaemic women with known haemoglobinopathy what to check prior to starting iron?

Serum ferritin ( iron deficiency can cause some lowering of HbA2 percentage) ❤ offer oral supplements if ferritin < 30 mg/L

How much of dietary iron is absorbed?

15%

What is the recommended iron daily intake in pregnancy?

30 mg / d The requirements in pregnancy are 3 times higher than menstruating women.

What are the iron daily requirements in pregnancy?

Early pregnancy: 1-2 mg / d 3rd trimester: 6 mg / d

Which one is better absorbed ferrous or ferric salts?

Ferrous salts is better absorbed

What are the factors that enhance iron absorption?

Haem iron Ferrous iron ( Fe+2) Ascorbic acid

What are the factors that inhibit iron absorption?

Food rich in ca Tannins in tea Phytates in cereals

What are the variations of elemental iron in each salt?

Fumarate/ sulphate: 200 mg 👉 65 mg Gluconate : 300 mg 👉 35 mg

How to take iron supplements correctly?

On an empty stomach 1 hour before meals with a source of vit c

When to offer iron supplements in pregnancy?

Hb < 11 up until 12 weeks Hb< 10.5 beyond 12 weeks

What are the indications for assessment of serum ferritin in non anaemic women?

Previous anaemia Multiparty > 3 Consecutive pregnancy < 1 year Vegetarians Teen pregnancies Recent history of bleeding High risk of bleeding Jehovah's witnesses

What kind of iron preparations should be avoided?

Enteric coated/ sustained release ( the majority of iron is carried past the duodenum

When to check Hb in the postpartum period ?

Within 48 hours of ⏰ In : 1- estimated blood loss > 500 ml 2- uncorrected anaemia detected in the antenatal period 3- symptoms suggestive of anaemia.

What are the contraindications of parenteral iron therapy?

1- history of anaphylaxis 2- 1st trimester of pregnancy 3- acute or chronic infection 4- liver disease

What is the most commonly used IV iron preparation in pregnancy?

Iron sucrose / iron dextran 🌷Sucrose has a higher availability for erythropoiesis 🛑 require multiple infusions

What is the only IM iron preparation available?

Iron dextran

What are the fast acting IV iron preparations ?

Iron ³ carboxymaltose Iron ³ isomaltoside ☀️ dose for carboxymaltose: Single dose 1000 mg / 15 minutes

What are the recommendations for women who are still anaemic at the time of delivery?

Cut-off: Hb< 10 👉 delivery in the hospital Hb< 9.5 👉obstetric led unit 1- IV access 2- blood group and save 3- active management of the third stage of labour 4- IM syntocinon / syntometrine 5- ( prolonged labour/ instrumental delivery) : IV high dose of syntocinon 6- misoprestol may be used

What is the relative risk reduction of anaemia at term if universal supplementation with 60 mg / d from 2nd trimester is applied?

30 - 50 %