Complete guide on anaemia in pregnancy including causes, WHO definition, diagnosis, iron requirements, IFA tablets, NIAP, Anemia Mukt Bharat, treatment & management.
Great — I made **30 concise, high-yield case scenarios** on anaemia in pregnancy. Each case includes: brief history/exam, key labs, working diagnosis, immediate management, definitive treatment plan, and follow-up. I kept dosing and practical steps clear so you can paste these into teaching slides, case banks or clinical notes.
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# 30 Case Scenarios — Anaemia in Pregnancy (with management)
> Legend: FS 325 mg ≈ 65 mg elemental Fe; typical oral treatment: **60–120 mg elemental Fe/day** (commonly 1 FS 325 mg once–three times daily depending on severity/tolerance). IV iron options: **iron sucrose** (commonly 100–200 mg per infusion repeated to calculated total) or **ferric carboxymaltose (FCM)** (single doses up to 750–1000 mg per product guidance). Transfusion generally considered for **Hb ≤7.0 g/dL** or symptomatic/hemodynamically unstable patient; tailor to obstetric context.
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### Case 1 — Mild IDA, first trimester
* Presentation: 24 y, G1P0, 10 wks, fatigue. Exam: pallor only.
* Labs: Hb 10.2 g/dL, MCV 74 fL, ferritin 8 ng/mL, Mentzer >13. Smear: microcytic hypochromic.
* Dx: Iron deficiency anaemia (mild).
* Immediate mgmt: Start oral iron — **FS 325 mg once daily** (≈65 mg elemental) + folic acid 400 µg; counsel on absorption and side effects.
* Definitive plan: Check Hb at 4 weeks; if Hb rising by ~1 g/dL, continue 3 months after normalization to replete stores. Diet & deworm if indicated.
---
### Case 2 — Moderate IDA, second trimester, poor diet
* Presentation: 29 y, 20 wks, progressive exertional dyspnea.
* Labs: Hb 8.3 g/dL, MCV 68 fL, ferritin 9 ng/mL.
* Dx: Moderate IDA.
* Immediate mgmt: Oral iron **FS 325 mg twice daily** (≈130 mg elemental/day) + folic acid; start vitamin C with dose. Consider adherence issues.
* Definitive plan: Reassess Hb in 2–3 weeks. If poor response or intolerance → switch to IV iron (calculate total deficit; consider FCM 1000 mg single or iron sucrose series).
---
### Case 3 — Severe symptomatic anaemia late pregnancy
* Presentation: 31 y, 36 wks, chest tightness, syncope history. Exam: tachycardia, low BP.
* Labs: Hb 5.8 g/dL, MCV 75 fL, ferritin 5 ng/mL.
* Dx: Severe IDA with hemodynamic compromise.
* Immediate mgmt: Resuscitate (IV fluids as needed), **blood transfusion** (matched PRBCs) — aim to stabilise; crossmatch and transfuse per obstetric transfusion protocol.
* Definitive plan: After stabilization, give IV iron (iron sucrose/FCM) to replete stores; counsel for delivery planning and postpartum follow-up.
---
### Case 4 — Late presentation, intolerance to oral iron
* Presentation: 26 y, 34 wks, vomiting with oral iron causing severe nausea.
* Labs: Hb 9.0 g/dL, ferritin 10 ng/mL.
* Dx: IDA with oral intolerance.
* Immediate mgmt: Stop oral iron; offer **IV iron** (iron sucrose series or FCM depending on availability) to correct quickly pre-delivery. Monitor vitals during infusion.
* Follow-up: Hb/ferritin 2–4 weeks post-infusion; resume oral prophylaxis postpartum.
---
### Case 5 — Refractory anaemia despite oral iron
* Presentation: 28 y, 22 wks, on FS 325 mg TID x 6 weeks, minimal Hb rise.
* Labs: Hb 9.2 g/dL, ferritin 6 ng/mL, reticulocyte low-normal.
* Dx: Non-response to oral iron (malabsorption, non-adherence, ongoing loss).
* Immediate mgmt: Evaluate adherence, check for parasites/GI blood loss. If adherence OK → **IV iron**. Consider stool testing for hookworm. Screen for celiac if suspicion.
* Definitive plan: Treat underlying cause; calculate iron deficit and give IV iron.
---
### Case 6 — Microcytosis suspicious for thalassaemia trait
* Presentation: 21 y, 12 wks, mild pallor. Labs: Hb 10.8 g/dL, MCV 65 fL, RBC count high, Mentzer <13, ferritin normal 50 ng/mL.
* Dx: Likely β-thalassaemia trait.
* Mgmt: Confirm with **Hb electrophoresis (elevated HbA₂)**. Do **not** give high-dose iron if ferritin normal. Genetic counselling and partner screening. Provide routine antenatal care; avoid unnecessary iron.
---
### Case 7 — Anaemia of chronic disease (ACD)
* Presentation: 34 y, known lupus, 28 wks, fatigue. Labs: Hb 9.6 g/dL, ferritin 180 ng/mL, low serum iron, low TIBC. CRP high.
* Dx: ACD due to chronic inflammation.
* Mgmt: Treat underlying disease flare; iron supplementation only if true iron deficiency coexists (assess transferrin saturation). Consider erythropoiesis-stimulating agents only in specialist settings; consult rheumatology/hematology.
---
### Case 8 — Folate deficiency plus iron deficiency
* Presentation: 27 y, 24 wks, paresthesia, macrocytic indices. Labs: Hb 8.9 g/dL, MCV 108 fL, low B12.
* Dx: B12 deficiency.
* Mgmt: **IM/SC cyanocobalamin** replacement (e.g., 1000 µg IM weekly × several doses then monthly) depending on cause; treat concurrently with folate if needed. Neurologic signs may take months to improve.
---
### Case 10 — Postpartum haemorrhage with acute blood loss
* Presentation: 35 y, day 1 postpartum after PPH, tachycardic, Hb 6.1 g/dL.
* Dx: Acute severe anaemia from blood loss.
* Mgmt: Immediate resuscitation; **urgent transfusion** (PRBCs), manage bleeding source (surgical/medical). After stabilization consider IV iron for repletion.
---
### Case 11 — Twin pregnancy with increased iron need
* Presentation: 32 y, twin gestation 28 wks, fatigue. Labs: Hb 9.0 g/dL, ferritin 12 ng/mL.
* Dx: IDA in multiple pregnancy.
* Mgmt: Start **oral iron** at treatment dose (FS 325 mg twice daily) and consider early IV iron if inadequate response or near-term to optimize Hb before delivery. Close monitoring.
---
### Case 12 — Hyperemesis gravidarum causing iron deficiency
* Presentation: 22 y, 10 wks, severe vomiting; poor intake. Labs: Hb 9.8 g/dL, ferritin 15 ng/mL.
* Dx: IDA from poor intake.
* Mgmt: Correct dehydration, antiemetics + start **oral iron** when tolerated (consider IV iron if vomiting prevents oral intake). Nutritional support and folate.
---
### Case 13 — Hookworm infection causing chronic blood loss
* Presentation: 25 y, 26 wks, pica, eosinophilia. Labs: Hb 8.7 g/dL, ferritin 7 ng/mL. Stool: ova consistent with hookworm.
* Dx: IDA due to helminthiasis.
* Mgmt: Treat hookworm per local protocol (deworming timing per antenatal policy; e.g., single-dose albendazole often after first trimester in many settings), start oral iron or IV iron if severe; public-health measures.
---
### Case 14 — Malaria-associated anaemia in pregnancy
* Presentation: 28 y, febrile 30 wks, pallor, splenomegaly. Labs: Hb 7.9 g/dL, smear positive for Plasmodium.
* Dx: Malaria-related anaemia.
* Mgmt: Treat malaria urgently with pregnancy-safe antimalarial per local guideline; transfuse if severe/symptomatic; start iron only after clearing infection and per clinician judgment.
---
### Case 15 — HIV with anaemia of multifactorial cause
* Presentation: 29 y, known HIV on ART, 20 wks, fatigue. Labs: Hb 9.0 g/dL, ferritin 90 ng/mL, MCV variable.
* Dx: Multifactorial (ACD, drug-related, nutritional).
* Mgmt: Review ART (e.g., zidovudine can cause anaemia), treat nutritional deficiencies, consider IV iron if IDA confirmed and oral therapy fails; coordinate with HIV care.
---
### Case 16 — Renal disease with anemia in pregnancy
* Presentation: 36 y, CKD stage 3, 24 wks, low energy. Labs: Hb 8.6 g/dL, ferritin 150 ng/mL, low reticulocyte.
* Dx: Anaemia of CKD/ACD.
* Mgmt: Nephrology consult; consider IV iron if iron-deficient; consider erythropoiesis stimulating agents in specialist setting; optimise dialysis/renal care.
---
### Case 17 — Recurrent anemia after oral iron completion
* Presentation: 27 y, previously treated IDA, returns 3 months postpartum with Hb 9.5 g/dL. Ferritin low 12 ng/mL.
* Dx: Recurrent iron deficiency.
* Mgmt: Reassess for ongoing bleeding; restart iron therapy; investigate heavy menstrual bleeding; counsel on compliance and diet; consider long-term iron strategy until cause fixed.
---
### Case 18 — Anaemia with allergic reaction to IV iron history
* Presentation: 30 y, history of anaphylaxis to IV iron dextran. Now 30 wks, Hb 7.5 g/dL.
* Dx: Severe IDA with prior IV iron allergy.
* Mgmt: Avoid offending agent; use non-dextran formulations (iron sucrose or FCM) under monitored conditions with resuscitation available; consider transfusion if urgent and risk high.
---
### Case 19 — Mixed thalassaemia trait + iron deficiency
* Presentation: 23 y, MCV 68 fL, Mentzer borderline, ferritin low 10 ng/mL.
* Dx: Mixed iron deficiency + thalassaemia trait.
* Mgmt: Treat iron deficiency (oral/IV as needed) — correct iron first and reassess indices; refer to hematology/genetic counselling for thalassaemia.
---
### Case 20 — Severe anaemia with cardiac compromise
* Presentation: 38 y, 34 wks, signs of high-output cardiac failure (orthopnea), Hb 6.5 g/dL.
* Dx: Severe anaemia causing cardiac strain.
* Mgmt: Urgent transfusion and cardiac support; plan delivery in appropriate setting once stabilized; consider IV iron after haemodynamic stability.
---
### Case 21 — Antenatal screening finds microcytic anaemia in partner/partner screening scenario
* Presentation: 26 y, first visit, Hb 11.1 g/dL but MCV 72 fL. Ferritin 40 ng/mL. RBC count high. Mentor index <13.
* Dx: Possible thalassaemia trait carrier.
* Mgmt: Do Hb electrophoresis; if positive, offer partner testing and genetic counselling; avoid unnecessary iron if iron stores adequate.
---
### Case 22 — Severe anaemia in adolescent pregnant patient
* Presentation: 17 y, 18 wks, symptomatic, Hb 7.2 g/dL.
* Dx: Severe IDA.
* Mgmt: Consider transfusion if symptomatic; otherwise start IV iron if available; add nutritional counselling, address social determinants (poverty/diet), involve adolescent health services.
---
### Case 23 — Anaemia discovered during labour
* Presentation: 30 y, in labor, known Hb 8.0 g/dL on admission.
* Dx: Moderate IDA at delivery.
* Mgmt: Plan for blood availability if bleeding risk high; give IV iron postpartum if Hb fails to improve and prolonged recovery expected; active management of third stage of labour to avoid PPH.
---
### Case 24 — Severe IDA with late booking and need for rapid correction before c-section
* Presentation: 33 y, booked at 38 wks, Hb 8.0 g/dL, scheduled c-section next week.
* Dx: IDA needing rapid optimization.
* Mgmt: Give **IV iron (FCM 1000 mg if available)** to increase Hb/iron stores quickly pre-op; if immediate correction required and Hb very low → transfuse perioperatively.
---
### Case 25 — Anaemia in pregnancy with concurrent sepsis
* Presentation: 29 y, fever, Hb 8.4 g/dL, high CRP.
* Dx: Anaemia with infective/inflammatory component.
* Mgmt: Treat infection promptly; avoid confounding ferritin interpretation; if iron deficiency coexists and severe → consider IV iron once infection controlled; transfuse if hemodynamically unstable.
---
### Case 26 — Peripartum transfusion reaction risk scenario
* Presentation: 35 y, urgent PPH, requires transfusion; prior transfusion history with antibodies.
* Dx: Acute blood loss anaemia with alloimmunisation risk.
* Mgmt: Coordinate blood bank for phenotype-matched units; transfuse as required; consider tranexamic acid and uterotonics; document antibody and counsel for future pregnancies.
---
### Case 27 — Anaemia with hemolysis (autoimmune)
* Presentation: 31 y, jaundice, Hb 7.6 g/dL, elevated LDH, indirect bilirubin, positive direct Coombs.
* Dx: Autoimmune hemolytic anemia (AIHA) in pregnancy.
* Mgmt: Hematology consult; treat (corticosteroids first-line), transfusion if needed (with crossmatch); avoid IV iron while active hemolysis unless iron deficient; monitor fetus for hydrops if severe.
---
### Case 28 — Iron overload concern (hemochromatosis suspicion)
* Presentation: 34 y, elevated ferritin 500 ng/mL, high transferrin saturation, mild anemia. Family history of hemochromatosis.
* Dx: Possible iron overload or inflammation.
* Mgmt: Evaluate for hereditary hemochromatosis outside pregnancy (genetic testing, specialist input); avoid unnecessary iron; treat underlying cause of high ferritin (inflammation vs overload).
---
### Case 29 — Antenatal prophylaxis non-adherence with borderline anaemia
* Presentation: 28 y, missed many ANC visits, Hb 10.6 g/dL, ferritin 22 ng/mL.
* Dx: Borderline anemia/early IDA.
* Mgmt: Reinforce routine prophylaxis (30–60 mg elemental iron + folic acid), provide education, address barriers (side effects, access), recheck Hb in 4 weeks and treat if progresses.
---
### Case 30 — Severe postpartum anaemia with breastfeeding
* Presentation: 27 y, 2 weeks postpartum, Hb 6.8 g/dL, symptomatic (dizziness), breastfeeding.
* Dx: Severe postpartum anaemia (likely iron deficient).
* Mgmt: Consider transfusion if symptomatic/severe; give IV iron if breastfeeding and stable (IV iron safe in lactation); if oral is chosen, counsel on adherence and side effects; follow-up Hb and ferritin, continue iron 3 months after repletion.
---
# Quick management reminders (pasteable)
* **Screening**: Hb at booking and at 28 wks.
* **Oral iron**: FS 325 mg ≈ 65 mg elemental; treatment = **60–120 mg elemental/day** until stores replete. Take on empty stomach with vitamin C; separate from antacids.
* **IV iron**: Use for intolerance, non-response, late pregnancy needing rapid correction, malabsorption, or severe anaemia when oral not feasible. Iron sucrose (100–200 mg per dose) or FCM (single large dose 750–1000 mg). Monitor for reactions.
* **Transfusion**: Individualise. Usually **Hb ≤7.0 g/dL** or symptomatic/hemodynamic compromise → transfuse. In obstetrics, clinical scenario dictates threshold.
* **Follow-up**: Check Hb 2–4 weeks after therapy start and continue iron for 3 months after normalization.
---
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# Anaemia in pregnancy — complete, stylish clinical note
> Compact, exam-friendly, evidence-backed reference you can paste into notes or teaching slides. Sources for the most important guideline facts are cited inline.
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## 1) Definition (WHO)
Anaemia = low haemoglobin (Hb) or red-cell mass causing reduced O₂-carrying capacity.
**WHO threshold in pregnancy:** **Hb < 110 g/L (11.0 g/dL)** = anaemia; **severe** = **< 70 g/L (7.0 g/dL)**. ([World Health Organization][1])
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## 2) Pathophysiology (short)
* Pregnancy → plasma volume ↑ ≈ 30–50% while red-cell mass ↑ less → physiologic haemodilution (lower Hb).
* Pathologic anaemia results when iron supply (diet + stores) cannot meet increased maternal/fetal demands → reduced haemoglobin synthesis → microcytic hypochromic RBCs (longstanding).
* Other mechanisms: haemoglobinopathy, folate/B12 deficiency, chronic inflammation (anemia of chronic disease, ACD), hemolysis, acute blood loss.
---
## 3) Iron requirements in pregnancy & prophylaxis (practical)
* Pregnancy increases iron need substantially (for maternal RBC mass, placenta and fetus). Guidelines recommend **daily oral iron 30–60 mg elemental iron + 400 µg folic acid** for routine antenatal prophylaxis (start early, usually from 12 weeks or at first contact per local policy). For treatment, higher elemental doses are used (see below). ([World Health Organization][2])
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## 4) Public-health: Anemia Mukt Bharat & IFA logistics (India)
* **Anemia Mukt Bharat (NHM)** emphasises six strategic actions including IFA supplementation, deworming, food fortification, testing & treatment, behaviour change and special management of severe cases. Weekly IFA formulations for adolescents/adults vary by group (e.g., 45–60 mg elemental iron + folic acid 400–500 µg for weekly program tablets); pregnant women receive daily IFA through ANC (tablet composition and supply per NHM/ANC). ([National Health Mission][3])
> Note about **“I-NIAP”**: I searched for a standard term “I-NIAP” and could not find an established definition. In obstetric literature you’ll see **AIP / NAIP** (Anemia In Pregnancy / Non-Anemic In Pregnancy) used in studies. If you meant a specific program/term, tell me and I’ll fetch it. ([sid.ir][4])
* IDA: microcytic hypochromic RBCs, anisopoikilocytosis, pencil cells.
* ACD: often normocytic or mildly microcytic with low serum iron but low TIBC. Ferritin is normal or high in ACD (acute phase reactant).
**Hb electrophoresis**
* Indication: to detect β-thalassaemia trait or other hemoglobinopathies when indices suggest trait (normal/high RBC count, low MCV, Mentzer <13). Confirm with HbA₂ levels. ([PMC][7])
**Ferritin interpretation**
* Low ferritin confirms iron deficiency; ferritin is raised in inflammation — interpret with CRP/ESR. WHO/technical guidance gives ferritin cutoffs and handling when inflammation present. ([World Health Organization][8])
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## 8) IDA vs Anaemia of Chronic Disease (ACD) — key contrasts
* **IDA:** low ferritin, low serum iron, high TIBC (or normal), low transferrin saturation; microcytic hypochromic RBCs.
* **ACD:** low serum iron, **low/normal TIBC**, normal/high ferritin, low transferrin saturation; usually occurs with infection/inflammation/chronic disease. Treatment targets underlying disease + careful iron management. ([World Health Organization][8])
---
## 9) Differential diagnoses to consider
* Iron deficiency, haemoglobinopathies (thalassaemia trait), folate/B12 deficiency, ACD, hemolytic anaemias, blood loss (antepartum/PPH), bone marrow disorders.
---
## 10) Complications & adverse effects of anaemia in pregnancy
**Maternal effects**
* Fatigue, reduced work capacity, increased risk of cardiac failure if severe, increased risk of peripartum transfusion and infection, poor wound healing, higher maternal mortality in severe anaemia. ([World Health Organization][9])
**Goals:** correct Hb, replete iron stores (ferritin), prevent recurrence, avoid transfusion when possible.
### A. Prevention (policy/antenatal)
* Diet counselling (iron-rich foods + vitamin C to increase absorption; avoid tea/coffee with meals).
* Routine **daily IFA prophylaxis: 30–60 mg elemental iron + 400 µg folic acid** (WHO). For national programs (India) follow Anemia Mukt Bharat / ANC protocols for supply and deworming. ([World Health Organization][2])
### B. Oral iron — first-line for mild–moderate IDA and prophylaxis
**Common salts & elemental iron content (practical)**
**Indication (pregnancy):** treatment when IDA confirmed (mild–moderate), prophylaxis as above.
**Dosing (typical)**
* **Prophylaxis:** 30–60 mg elemental iron daily + 400 µg folic acid. ([World Health Organization][2])
* **Treatment (common practice):** many formularies use **60–120 mg elemental iron daily** (often given as 1 tab of ferrous sulfate 325 mg × 1–3 daily depending on severity) or **single daily higher elemental dose**; some guidelines/recent studies favour **lower daily doses (e.g., 60–80 mg elemental once daily)** or alternate-day dosing to improve tolerance and absorption — tailor to local guidance and tolerance. ([ScienceDirect][11])
**Mechanism of action:** provides elemental iron for haemoglobin synthesis; absorbed in duodenum via DMT1 after reduction to ferrous form.
**Pharmacokinetics (summary):** oral iron variably absorbed (5–30% depending on iron status, enhancers/inhibitors). Food reduces absorption; vitamin C enhances.
**Adverse effects (oral):** GI upset, nausea, abdominal pain, constipation or diarrhoea, black stools; adherence often limited by GI side effects. ([National Health Mission][12])
**Contraindications:** known hypersensitivity; caution with hemochromatosis. Check for haemoglobinopathy before prolonged high-dose therapy.
**Key interactions:** antacids, calcium, tetracyclines, some antibiotics — separate dosing by 2–3 hours. Vitamin C coadministration improves absorption.
**Monitoring:** Hb every 2–4 weeks until rise (aim Hb ↑ by ~1 g/dL in 2–4 weeks), ferritin at baseline and after repletion; monitor adherence and GI side effects.
**Counselling points to patient:** take on empty stomach if tolerated (or with small vitamin-C-rich juice), avoid tea/coffee within 1–2 hours, black stools are common and harmless, constipation can be managed with stool softener/diet. Keep out of reach of children (ingestion is toxic).
---
### C. Parenteral (IV) iron — when to use
**Indications in pregnancy**
* Severe IDA not corrected by oral iron, intolerance or non-adherence to oral iron, late pregnancy where rapid correction needed, malabsorption, ongoing significant bleeding, or when quick Hb rise needed before delivery/cesarean. Avoid routine use in first trimester when possible. ([Wiley Online Library][13])
**Preparations & dosing (practical)**
* **Iron sucrose (Venofer):** repeated doses (e.g., 100–200 mg per infusion; typical cumulative calculated by Ganzoni or dosing tables). Max ~200 mg per infusion commonly used; total depends on deficit. ([transfusionguidelines.org][14])
* **Ferric carboxymaltose (FCM; Injectafer/Ferinject):** allows **larger single doses (up to ~750–1000 mg per infusion, product-specific limits ~15–20 mg/kg, max 1000 mg single dose)** — useful to correct iron deficit quickly in 1–2 visits. ([injectaferhcp.com][15])
**Mechanism:** IV complexes deliver iron directly to reticuloendothelial system for incorporation into ferritin/haemoglobin.
**Adverse effects (IV):** infusion reactions (including rare anaphylaxis with older dextran formulations), transient hypotension, nausea, arthralgia, local irritation; hypophosphatemia reported with some agents (e.g., FCM). Monitor for hypersensitivity during infusion. ([PMC][16])
**Monitoring:** vitals during infusion, monitor Hb/ferritin 2–4 weeks post infusion; check phosphate if using FCM and high cumulative dose.
**Counselling:** explain need for IV access, possible transient side effects, and post-infusion monitoring.
---
### D. Blood transfusion — when & how (obstetric specifics)
**Indications:** individualised — combine clinical state and Hb level. Many guidelines say transfusion is usual when **Hb < 60–70 g/L** or if symptomatic/hemodynamically unstable; rarely needed if Hb > 100 g/L. In obstetrics, clinical context (ongoing bleeding, cardiovascular compromise, labour) is decisive. Cross-match and plan ahead for high-risk women. Use single donor PRBCs, match Rh/K testing, and consider component therapy. ([RCOG][17])
**Risks:** transfusion reactions, alloimmunisation, infection risk (low with modern screening), transfusion-associated circulatory overload; plan restrictive transfusion strategy where safe.
1. **Screen all pregnant women at booking** (Hb + RBC indices). If Hb <110 g/L → further tests (CBC, ferritin ± iron studies). ([World Health Organization][1])
2. **If IDA confirmed (low ferritin):** start/optimise oral iron (elemental 60–120 mg/day, adjust to tolerance). Counsel. Monitor Hb rise at 2–4 weeks. If inadequate response or very late pregnancy / urgent correction required → **IV iron** (calculate total deficit; consider FCM or iron sucrose per availability). ([ScienceDirect][11])
3. **If severe symptomatic anaemia (Hb <70 g/L) or haemodynamic instability:** consider blood transfusion (obstetric judgement). ([RCOG][17])
---
## 13) Prevention of recurrence & antenatal program tips
* Give full course until 3 months postpartum if previously anaemic, ensure deworming (in areas endemic for helminths) per national policy, ensure adequate dietary counselling, consider screening for haemoglobinopathies if family history or persistent microcytosis after iron repletion. Use Anemia Mukt Bharat operational modules to plan community IFA distribution and counselling. ([i4n.in][18])
**A. ANC counselling line:** “You have mild iron deficiency. I’m starting oral iron (example: ferrous sulfate 325 mg **once daily** = ~65 mg elemental iron) + folic acid — take on empty stomach or with orange juice, expect black stools; call if severe abdominal pain or fainting.”
**B. IV iron note:** “Given poor response/intolerance to oral iron or late pregnancy, plan IV ferric carboxymaltose **(calculate total deficit; often one 1000 mg infusion)** — monitor vitals during infusion, check Hb & ferritin at 2–4 weeks.”
---
## 16) References / further reading (selected, guideline-level)
* WHO Anaemia fact sheet & Hb thresholds. ([World Health Organization][9])
* WHO recommendations: daily iron & folic acid supplementation in pregnancy. ([World Health Organization][2])
* Anemia Mukt Bharat training & operational guidance (India/NHM). ([National Health Mission][3])
* Mentzer index & RBC indices literature. ([PMC][6])
* IV iron reviews & product dosing (iron sucrose, ferric carboxymaltose) and obstetric use. ([PMC][16])
* RCOG / Green-top on blood transfusion in obstetrics. ([RCOG][17])
---
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[1]: https://cdn.who.int/media/docs/default-source/anaemia-in-women-and-children/hb-methods-for-gather.pdf?sfvrsn=da0fbb5f_11&utm_source=chatgpt.com "WHO methods and data sources for mean haemoglobin ..."
[2]: https://www.who.int/tools/elena/interventions/daily-iron-pregnancy?utm_source=chatgpt.com "Daily iron and folic acid supplementation during pregnancy"
[3]: https://nhm.gov.in/index1.php?lang=1&level=3&lid=797&sublinkid=1448&utm_source=chatgpt.com "Anaemia Mukt Bharat"
[4]: https://www.sid.ir/paper/1056249/en?utm_source=chatgpt.com "Haemoglobin Level of Pregnant Women on First ..."
[5]: https://www.msdmanuals.com/professional/multimedia/table/typical-normal-serum-values-for-iron-iron-binding-capacity-ferritin-and-transferrin-saturation?utm_source=chatgpt.com "Table: Typical Normal Serum Values for Iron, Iron-Binding ..."
[6]: https://pmc.ncbi.nlm.nih.gov/articles/PMC9121960/?utm_source=chatgpt.com "Role of Mentzer index for differentiating iron deficiency ..."
[7]: https://pmc.ncbi.nlm.nih.gov/articles/PMC5467296/?utm_source=chatgpt.com "Iron Deficiency Anemia or β-Thalassemia Trait? - PMC"
[8]: https://www.who.int/docs/default-source/micronutrients/ferritin-guideline/ferritin-guidelines-brochure.pdf?sfvrsn=76a71b5a_4&utm_source=chatgpt.com "ferritin-guidelines-brochure.pdf"
[9]: https://www.who.int/news-room/fact-sheets/detail/anaemia?utm_source=chatgpt.com "Anaemia"
[10]: https://www.ncbi.nlm.nih.gov/books/NBK548214/table/Iron.T1/?utm_source=chatgpt.com "[Table, Concentrations of elemental iron in typical iron tablets]"
[11]: https://www.sciencedirect.com/science/article/pii/S0098299720300364?utm_source=chatgpt.com "Oral iron supplementation in iron-deficient women"
[12]: https://nhm.gov.in/images/pdf/programmes/wifs/guidelines/icds_operational_guidelines_for_wifs.pdf?utm_source=chatgpt.com "Operational Guidelines for Weekly IFA Supplementation ..."
[13]: https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.27220?utm_source=chatgpt.com "Expert consensus guidelines: Intravenous iron uses, ..."
[14]: https://www.transfusionguidelines.org/document-library/documents/protocol-for-the-use-of-iv-iron-sucrose/download-file/rtc-eeng_protocol_iv_iron_sucrose.pdf?utm_source=chatgpt.com "IV iron sucrose Venofer protocol v1.0 Jan08"
[15]: https://injectaferhcp.com/iron-injection-administration?utm_source=chatgpt.com "Dosing and Administration"
[16]: https://pmc.ncbi.nlm.nih.gov/articles/PMC9722303/?utm_source=chatgpt.com "Ferric Carboxymaltose in the Management of Iron ..."
[17]: https://www.rcog.org.uk/media/sdqcorsf/gtg-47.pdf?utm_source=chatgpt.com "Blood Transfusion in Obstetrics"
[18]: https://www.i4n.in/wp-content/uploads/2023/05/Anemia-Mukt-Bharat-Training-Modules-english.pdf?utm_source=chatgpt.com "ANEMIA MUKT BHARAT"
