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6-Iron Deficiency In Pregnancy/ Rcog > Uk. GuideLines > Flashcards

Uk. GuideLines Flashcards

1
Q

What is the prevalence of iron deficiency globally?

A

2 billion people

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2
Q

What is the definition of anaemia in pregnancy?

A

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

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3
Q

When CBC should be assessed in normal pregnancy?

A

At booking
At 28 weeks

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4
Q

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

A

NO

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

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

A

100 - 200 mg / daily of elemental iron

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8
Q

When to consider referral anaemic women to secondary care ?

A

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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9
Q

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

A

❤ preparation with lower iron content should be tried

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10
Q

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

A

For 3 months and at least 6 weeks postpartum

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11
Q

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

A

65 mg / daily
Repeat Hb / ferritin after 8 weeks

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12
Q

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

A

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

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13
Q

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

A
  • fail to respond to oral iron
  • intolerant of oral iron
  • proven malabsorption
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14
Q

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

A

❤ 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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15
Q

What is the prevalence of iron deficiency anemia in pregnancy?

A

30- 40 %

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16
Q

What are the maternal effects of iron deficiency anemia?

A

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

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17
Q

What is the Hb threshold below which maternal mortality increases?

A

8.9 g / dl
Associated with doubling of maternal death

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18
Q

What are the fetal effects of iron deficiency anemia?

A

Fetus is protected by upregulation of placental iron transport protein

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19
Q

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

A

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

20
Q

What are the clinical symptoms of iron deficiency anemia?

A

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

21
Q

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

A

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

22
Q

What are the laboratory tests findings in iron deficiency anemia?

A

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

23
Q

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

A

Serum ferritin
Not affected by recent iron ingestion

24
Q

How serum ferritin concentrations varies during pregnancy?

A
  • initially rises
  • fall by 32 weeks (to about 50 % prepregnancy levels)
  • mildly increase in 3rd trimester.
25
Q

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

A

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

26
Q

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

A

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

27
Q

What is the gold standard for assessment of iron stores?

A

Bone marrow sample stained for iron

28
Q

In a trail of iron therapy when to check Hb ?

A

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

29
Q

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

A

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

30
Q

How much of dietary iron is absorbed?

A

15%

31
Q

What is the recommended iron daily intake in pregnancy?

A

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

32
Q

What are the iron daily requirements in pregnancy?

A

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

33
Q

Which one is better absorbed ferrous or ferric salts?

A

Ferrous salts is better absorbed

34
Q

What are the factors that enhance iron absorption?

A

Haem iron
Ferrous iron ( Fe+2)
Ascorbic acid

35
Q

What are the factors that inhibit iron absorption?

A

Food rich in ca
Tannins in tea
Phytates in cereals

36
Q

What are the variations of elemental iron in each salt?

A

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

37
Q

How to take iron supplements correctly?

A

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

38
Q

When to offer iron supplements in pregnancy?

A

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

39
Q

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

A

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

40
Q

What kind of iron preparations should be avoided?

A

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

41
Q

When to check Hb in the postpartum period ?

A

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

42
Q

What are the contraindications of parenteral iron therapy?

A

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

43
Q

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

A

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

44
Q

What is the only IM iron preparation available?

A

Iron dextran

45
Q

What are the fast acting IV iron preparations ?

A

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

46
Q

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

A

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

47
Q

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

A

30 - 50 %

6-Iron Deficiency In Pregnancy/ Rcog (1 decks)

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