DESCRIPTION
Haemoglobin (Hb) <11 g/dL. Anaemia in pregnancy is mostly due to either iron deficiency, folic acid deficiency or a combination of both. Women with iron deficiency may have ‘pica’, e.g. eating substances such as soil, charcoal, ice, etc.
GENERAL MEASURES
A balanced diet to prevent nutritional deficiency.
MEDICINE TREATMENT
Prophylaxis
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Ferrous sulphate compound BPC, oral, 170 mg daily with a meal.
PLUS
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Folic acid, oral, 5 mg daily.
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Continue with iron and folic acid supplementation during lactation.
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Treat other causes of anaemia according to the diagnosis.
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Folic acid deficiency
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Folic acid, oral, 5 mg daily.
Identify and treat associated vitamin deficiencies accordingly.
Iron deficiency
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Ferrous sulphate compound BPC, oral, 170 mg 8 hourly with meals.
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Continue for 3–6 months after the Hb reaches normal to replenish iron stores.
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Hb is expected to rise by at least 1.5 g/dL in two weeks.
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If Hb does not increase after two weeks, do a full blood count (FBC) to confirm hypochromic microcytic anaemia.
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When using iron together with calcium supplementation, ensure that iron and calcium are taken at least 4 hours apart from one another.
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Parenteral iron
If there is no response to oral iron, review adherence and do a FBC. If iron deficiency is confirmed on FBC and oral iron is not tolerated consider intravenous iron sucrose using the following formula:
Total dose = weight (kg) x [11 g/dL – actual Hb (g/dL)] x 2.4 + 200 mg.
Maximum daily dose: 200 mg.
Administer over 30 minutes in 200 mL sodium chloride 0.9%. Repeat every second day until the total dose is given.
If delivery is anticipated within 3–5 days, consider blood transfusion in women with a Hb <7 g/dL.
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