[CG] Haemoglobin less than 105g per L obstetric management

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If Hb <105g/l, check

  • FBC and blood film
  • Serum ferritin

If ferritin <50, commence oral replacement therapy

  • commence ferrous fumarate 210mg tid (contains 68mg elemental iron per tablet), 2nd line management ferrous sulphate 200mg tid to be used only when ferrous fumarate not available

If ferritin >50, 

  • Consider other causes of anaemia
  • If strong clinical suspicion of iron deficiency anaemia, consider checking serum iron and transferrin.

 Monitor Response

  • Check FBC every 4 weeks after commencing therapy
  • Hb level may take up to 6 weeks to respond
  • Check reticulocyte count if no response in Hb after 4 weeks – this will increase prior to rise in Hb and will indicate that RBC production is responding to therapy
  • If no response in reticulocyte count at 4 weeks, review diagnosis
  • Monitoring of response may need to be more frequent if anaemia treatment does not commence until the late second or third trimester
  • Haematinic replacement should continue until at least 6 weeks post partum, longer if significant post partum haemorrhage occurs
  • If iron deficiency is confirmed and there is no response to oral iron replacement or oral iron cannot be tolerated, intravenous iron may be used.

Last reviewed: 01 April 2016

Next review: 30 April 2019

Author(s): Updated on behalf of GONEC Group by: Lead Author Dr. Vicki Brace, Consultant Obstetrician, PRM; June Grant, Lead Clinical Pharmacist O & G Women & Children’s Directorate GGC; Dr Catherine Bagot, Consultant Haematologist, GRI

Version: 3

Approved By: Dr Catrina Bain, Clinical Director, Obstetrics GGC