Iron Anaemia 1

International Journal of Health, Nursing, & Medicine
ISSN: 2193-3715, Volume 2, Issue 1, page 7 - 13

Zambrut
Frequency of Iron Deficiency

Anaemia in Obstetrics
Population
(Case of Shahbaz Sharif Hospital - Indus Hospital, Pakistan)
Rukhsana Parveen1, Sadia Salman2, Rabya Arshad3, Ayesha Faisal4 & Shamaim Rehman5
1
Dr. Rukhsana Parveen, 2Dr. Sadia Salman, 3Dr. Rabya Arshad, 4Dr. Ayesha Faisal & 5Shamaim Rehman
1,2,3,4
Gynae Shahbaz Sharif Hospital Lahore
5
Muhammad Shahbaz Sharif Campus
Lahore, Pakistan
Abstract:
Objectives: This study was done to highlight the frequency of iron deficiency anemia in obstetrics population of
Shahbaz Sharif Hospital (INDUS hospital) Bedian road Lahore, Pakistan, so that affective remedies are
carried out to address iron deficiency among vulnerable obstetric population in this part of Pakistan. There has
been no such study conducted in this area.
Method: Total five hundred and sixty clinically anemic looking patients were selected from outpatient gynae
department at Shahbaz Sharif Hospital (INDUS hospital) Bedian road Lahore, Pakistan from January 2018 to
June 2018. After informed consent a detailed history and examination, preliminary blood tests including full
blood count, reticulocyte count, absolute blood count and blood film examination and serum Ferritin were done
in the laboratory. A clinical diagnosis was made based on the finding of history, clinical exam and blood tests.
Results: Out of 560 patients 521 had iron deficiency anemia and 39 were found to have non iron deficiency
anemia. Majority of patients with iron deficiency anemia were aged between 20-30 years (>60%). Severity of
iron deficiency was arbitrarily categorized into moderate and severe groups on basis of serum Ferritin level.
Majority of patients (48%) had severe iron deficiency anemia. Patients (38%) had moderate iron deficiency
anemia. Out of 560 patients, 73% patients were from rural areas. 27% were from urban population.
Conclusion: Iron deficiency is more common cause of anemia in Bedian road & nearby population . There are
many factors contributing to a high prevalence of iron deficiency which include poverty, malnutrition,
illiteracy, short inter-pregnancy interval due to lack of family planning awareness .
Keywords: Pregnancy, Anemia & Iron Deficiency.
1. INTRODUCTION
Anemia is a global public health problem affecting people in all age groups but the burden of
problem is higher in pregnant women (1). In developing countries anemia during pregnancy is multi-
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Parveen, R., Salman, S., Arshad, R., Faisal, A. & Rehman, S. 2019. Frequency of Iron Deficiency
Anaemia in Obstetrics .....................
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factorial and includes nutritional deficiencies of iron, folate and vitamin B12 and also parasitic diseases
like hook worm and malaria, however iron deficiency is the cause of 75% of anemia cases 1.
Pregnancy is the period in women’s life where physiological needs for iron are exceptionally high,
demand for absorbed iron increases gradually from 0.8 -1 mg/day in first trimester to 7.5 mg/day in last
trimester 2,5. Iron deficiency anemia is diminished red cell production due to low iron stores in body
confirmed by low iron stores and Hb level 2 standard deviation below normal (4). Serum ferritin reflects
iron stores and is most accurate test to diagnose iron deficiency. Although level below 15 ng/ml are
consistent with diagnosis of iron deficiency using cut off of 30 ng /ml improves sensitivity from 25-92%
and specificity remained high at 98 %. Ferritin value greater than or equal to 100 ng/ml generally excludes
iron deficiency anemia 2. Hb cannot be used as a marker of iron reserve because Hb remains constant over
wide range of serum ferritin concentration. Only when iron stores are completely exhausted, Hb starts to
decline 4, 6.
All pregnant women should be screened for iron deficiency anemia 2. Iron deficiency anemia in
pregnant women affects both mother and fetus. There is significant correlation between ferritin in mother
and newborn which shows that iron stores of newborn is dependent on iron stores of mother(2). Studies
from developing countries as well as from Singapore, Hongkong and USA have shown that presence of
iron deficiency anemia in mother significantly increases preterm birth, prematurity, low birth weight and
also increases peri-partum maternal morbidity and mortality(4) .
Reducing anemia is recognized as an important component of health of women and the second
global nutritional target for 2025 calls for 50% reduction of anemia in women of reproductive age 3. The
study aimed to assess the prevalence of iron deficiency anemia among pregnant women attending antenatal
care in MSSH (INDUS HOSPITAL LAHORE). As anemia in pregnant women still constitute major and
challengeable health problem and iron deficiency is major contributing factor, effort should focus on implementation
of early oral iron prophylaxis and on increasing the low compliance for prophylaxis program. (4) In Pakistan, various
studies have been performed among different areas to estimate the prevalence of this important public health
problem 8,9. There has been no study done in this area about very common and fairly treatable health condition. This
study is being conducted to assess the prevalence of this problem in the obstetrical population of Bedian road
&adjacent nearby areas, so that affective measures can be taken to treat this condition and reduce morbidities
associated with it.
2. MATERIALS
Obstetric patients visiting Shahbaz Sharif Hospital for antenatal care after detailed history and
investigations with Hb concentration less than 10 gm /dl between age 18-40 years. The rationale of this
study is to highlight the frequency of iron deficiency anemia in obstetrics population of Shahbaz Sharif
Hospital (INDUS hospital) Bedian road Lahore, Pakistan, so that affective remedies are carried out to
address iron deficiency among vulnerable obstetric population in this part of Pakistan. There has been no
such study conducted in this area.
3. METHODOLOGY
Total five hundred and sixty clinically anemic looking patients were selected from outpatient gynae
department at Shahbaz Sharif Hospital (INDUS hospital) Bedian road Lahore, Pakistan from
January 2018 to June 2018. After getting an informed consent,a detailed history was taken and entered on
predesigned proforma., It includes history of present illness, past illness, family history of anemia,
socioeconomic status, any history of blood loss, drug use, menstrual, gynecological and obstetrical history
in females, history of diarrhea, dysphagia, malaria, eating habits, quality and quantity of food consumed,
history of blood transfusion or donation and worm infestation A complete physical examination was
carried out later that included as detailed exam of hematopoietic system, looking for pallor, koilonychias,
lymphadenopathy, hepatomegaly, splenomegaly, purpura, bruises. Following these, preliminary blood tests
were performed on 5ml venous blood, including full blood counts by Automated method, Histogram were

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taken on automated analyzer and hemoglobin; blood indices and RDW was noted. The total Platelets,
reticulocyte counts and absolute values were done. Ferritin levels were checked. Serum ferritin values <
15ng/dl was considered diagnostic for severe iron deficiency. Cut offs for hemoglobin was 10g/dL.
4. RESULTS
Results of this study are shown in tables. 1-7. Iron deficiency anemia was the commonest type of
anemia affecting most of the patients. Out of 560 patients 521 had iron deficiency anemia and 39 were
found to have non iron deficiency anemia. Majority of patients with iron deficiency anemia were aged
between 20-30 years (>60%). Severity of iron deficiency was arbitrarily categorized into moderate and
severe groups on basis of serum Ferritin level. Majority of patients (48%) had severe iron deficiency
anemia. Patients (38%) had moderate iron deficiency anemia. Out of 560 patients, 73% patients were from
rural areas. 27% were from urban population.
Table 1: Type of anemia in patients

NUMBER OF
ANEMIA %AGE
PATIENTS
IRON DEFICIENCY 521 93.03
NON IRON DEFICIENCY 39 6.96
34-40 86 16.50
Table 2: Age distribution of iron deficiency anemia patients

AGE NUMBER OF PATIENTS % AGE
18-25 155 29.75
26-33 280 53.74
34-40 86 16.50
Table 3: Measurement of serum ferritin level, severity of iron deficiency anemia

SERUM FERRITIN LEVEL NUMBER OF PATIENTS %AGE
Ferritin <15 ng/dl 255 48.94
Ferritin 15-45 ng/dl 198 38.00
Ferritin 46-100 ng/dl 68 13.05
Table 4: Population distribution in iron deficiency anemia

LOCATION NUMBER OF PATIENTS %AGE
RURAL 399 76.58
URBAN 122 23.41

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Table 5: Statistical Comparison of Iron Deficiency Anemia

NO PARAMETERS TYPE OF PATIENT % Age
1 HEMOGLOBIN MILD ANEMIA 28.40%
( n=223 )
MODERATE ANEMIA 33.18%
( n= 202)
SEVERE ANEMIA 38.42%
(n=96)
2 GRAVIDITY PRIMIGRAVIDA (n=178) 34.16%
MULTIGRAVIDA (n=343)
65.83%
3 DURATION OF IST TRIMESTER (n=91 ) 17.46%

PREGNANCY 2ND TRIMESTER (n= 178)
3RDTRIMESTER (n=252) 34.16%
48.36%
4 SOCIOECONOMIC LOWER CLASS (n=282) 54.12%
STATUS MIDDLE CLASS (n=196)
UPPER CLASS (n=43) 37.61%
8.25%
Table 6: Distribution of iron deficiency anemia patients on the basis of CBC parameters:
RANGE OF NO. OF MEAN ± SD
NO. VARIABLE
VARIABLE PATIENTS n= 521 (RANGE)
Low (<76 fl) 161 71.35 ± 2.25(62-76)
1 MCV Normal(76-96 fl) 360 85.17 ±(76.10-96.00)
High (>76.96 fl) NIL NIL
29.78 ±2.35(20.70-
Low (<30) 356
29.90)
38.32 ±1.57(30.10-
2 MCHC Normal 30-35%) 153
35.00)
33.58 ±0.57(35.10-
High (>35%) 12
36.50)
25.98±2.79(20.20-
Low (<20 Pg) 312
31.50)
3 MCH 19.35±1.86(14.50-
Normal (20-30 Pg) 209
20.00)
High (>32 Pg) NIL NIL
Low (<4.5 Mill/Cu.mm) 398 3.65±0.65(1.91-4.50)
Normal (4.5-5
4 RBC 123 4.78±0.30(4.55-5.36)
Mill/Cu.mm)
High (>6.5Mill/Cu.mm) NIL NIL

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Table 7: Distribution of Iron Deficiency Anemic Patients on the Basis of Pregnancy Interval
Pregnancy Mean Interval+
No No. of Patients % Age
Interval Standard deviation
Less than 12
1 330 0.78±1.2 63.33 %
months
Between 12-24
2 136 16.2±3.1 26.1 %
months
More than 24
3 55 26.4±5.8 10.55 %
months
5. DISCUSSION
The present study was undertaken to determine the prevalence of iron deficiency anemia in
obstetrical population of Shahbaz Sharif hospital (Indus hospital) Bedian road, Lahore.
Iron deficiency is the most common deficiency state in the world, affecting more than 2 billion
people globally 5. Iron is crucial to biological functions, including respiration, energy production, DNA
synthesis and cell proliferation.6,14 Effective management is needed to prevent adverse maternal and
pregnancy outcomes including need for red cell transfusion 1. The prevalence of anemia in pregnant
women in developing countries is 56%.Around 65% of pregnant women in South Asia suffered from iron
deficiency anemia and in Indian subcontinent alone; the rate of developing iron def anemia is 88
%.(Akhter at al, 2013) 9,10. In a study by Gaming Khufu et al it is concluded that Screening for Iron
Deficiency Anemia in all pregnant women is recommended. Untreated IDA in pregnancy can result in
complications for the mother and fetus. 5,13
In the present study on the basis of serum ferritin of 280 anaemic patients 92.14 % of patients had
iron deficiency anaemia and 7.85 % had anaemia due to other causes. This is shown to be consistent with a
study by Ansari et al 12, where 90.5% of total pregnant women had iron deficiency anemia 2, 9. In the
present study the mean age of the pregnant women was 27.04 ± 4.4 years. A study from district Faisalabad
has reported a mean age of pregnant women 26 .07 ±5.04 years (Anjum et al)8. The patients with iron
deficiency anemia were subdivided on the basis of age into three groups. (18-25 yrs,26-33 yrs,34-40yrs).In
first group 31 % had IDA, in second group 54.26% had IDA while in the third group 14.72 %of patients
had IDA. According to these findings it was observed that findings of IDA were highest in 26-33 yrs age
group. Approximately same findings were observed in the study conducted in Bahawalpur region 7. This
is in contrast to study done in Karachi where the highest prevalence was in 31-35 age groups. 4
When assessing iron status, serum ferritin is the most reliable marker indicating iron deficiency. In
our study the serum ferritin level was divided in three groups (<15 ng /ml, 15-45 ng/ml, 46-100
ng/ml)56.58 % of patients had serum ferritin level <15 ng/ml, 35.6 % had levels between 37-65 % and
7.15 % had levels in range of 46-100 ng/ml. these findings were consistent with the study by Raza et al. 11
It was also observed that iron deficiency is more prevalent in rural areas (69.76%) as compared to
urban areas (30.23%). It was also observed that most of the patient with iron deficiency present with mild
(41%) to moderate (43%) anemia while only (15.55 %) had severe anemia at the time of presentation . as
iron stores are depleted with successive pregnancies prevalence of iron deficiency anemia is more in
multigravidas 60% as compared to primigravis (37.9 %).prevalence in primigravidas may be due to poor
dietary habits and already diminished iron stores among the population which deplete further during
pregnancy due to increased demand 5,7.
The association of anemia with socioeconomic class in present study 62.7% in low class, 37.2% in
middle class and 10 % in high class. Similar findings were observed in a study by Ullah et al,2013 12,13 as
fetal iron requirements increases with each trimester .This fact is also justified by our present study acc to

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which 50 % prevalence was found in third trimester and 18.6% and 30.2 % in 1st and 2nd trimesters
respectively.
According to French clinical study there was a significant risk of iron deficiency anemia in about
60% of women. Overall prevalence of anemia (15.8%) increases as duration of pregnancy advances
(46%).13, 16 These findings correlate with our study as frequency of iron deficiency anemia was 17.46% in
1st trimester and 48.36% in 3rd trimester.
There is significant relationship between short inter –pregnancy interval and frequency of iron
deficiency of anemia, which is 63.33 % if interval is less than 12 months and 10.55% if interval is more
than 12 months, which is consistent with French study and Anjum et al study in Faisalabad . 7,16
6. CONCLUSION:
Anemia is global public health problem which is more prevalent in obstetric population and
contributes to significant mortality and morbidity in Pakistan. There are many factors contributing to a
high prevalence of iron deficiency which include poverty, malnutrition, illiteracy, short inter-pregnancy
interval due to lack of family planning awareness . The aim of this study was to determine the frequency of
this problem in the obstetrical population of Bedian road & adjacent nearby areas and its associated
factors, so that effective clinical guidelines for healthcare professionals with clear and simple
recommendations for the prevention, diagnosis and treatment of iron deficiency anemia .
7. REFERENCES:
1. R.G.Vivek, A.B. Halappanavar, P.R. Vivek, S.B. Halki, V.S Maled and P.S.Deshpanda.Prevalence of
anaemia and its epidemiological determinants in pregnant women, 2012,5(3): 216-223
2. Matthew W.Short and Janson E Dongalska. Iron deficiency anaemia evaluation and management. Am
Fam Physician 2013 Jan 15;87(2) 98-104
3. WHO-the global prevalence of anemia in 2011. Geneva:world health organization 2015
4.Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer. Uk guideline on the management of
iron deficiency in pregnancy. British Journal of Hematology. 2012; 156:588-600
5. Gahmeng Khuu, Cheryl Dika, Iron deficiency anemia in pregnant women, The Nurse Practitioner 2017;
10(42):42-47
6. Saeed Ahmed Malik .et.al. Iron deficiency Anemia in Bahawalpur Region of Pakistan PJMHS. Vol.
10,No 1 Jan- March 2016
7. Saeed Ahmed Malik .et.al. Iron deficiency Anemia in Bahawalpur Region of Pakistan PJMHS. Vol.
10,No 1 Jan- March 2016
8. Anjum a, Manozoorm, Manzoor n, and Shakir h.a, 2015. Prevalence of Anemia During Pregnancy in
District Faisalabad, Pakistan. Punjab univ.j.zool, 30(1):15-20
9. Naz H, Begum B, Prevalence and Associated Risk Factors of Anemia in Pregnant Women in a Teaching
Hospital, Korangi industrial area. Pak J surg 2013;29(2): 131-133
10.Akhtar S, Ahmad A, Ali Z, Riaz M, Ismail T. Iron status of the Pakistani population-current issues and
strategies. Asia pac j clin nutr 2013;22(3): 340-347
11. Raza N, Sarwar I, Munazza B, Ayub M, Suleman M. Assessment of Iron Deficiency In Pregnant
Women by Determining Iron Status. J Ayub med coll Abbottabad 2011;23(2)
12. Ullah et al. prevalence of anaemia in pregnant women in district Karak, Khyber Pakhtunkhwa,
Pakistan. IJB 2013;3(11):77-83
13. Baig-Ansari N, Badruddin S.H, Karmaliani R, Harris H, Jehan I, Pasha O et al. prevelance and risk
factors in pregnant women in an urban area of Pakistan. Food NutrBull. 2008;29:132-9
14.Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional,
and national trends in haemoglobin concentration and prevalence of total and severe anaemia in
children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-
representative data. Lancet Glob Health. 2013;1:E16–E25. doi:10.1016/S2214-109X(13)70001-9.

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15. Global nutrition targets 2025: anaemia policy brief. Geneva: World Health Organization; 2014
(WHO/NMH/NHD/14.4;
http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_NHD_14.4_eng.pdf?ua=1, accessed 7
May 2015).
16. Thierry Harvey,Asma Zkik et al. Assessment of iron deficiency and anaemia in pregnant women:An
observational French study.Sage journal Jan 2016:1(12):95—102.
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International Journal of Health, Nursing, & Medicine

ISSN: 2193-3715, Volume 2, Issue 1, page 7 - 13

Frequency of Iron Deficiency

Keywords: Pregnancy, Anemia & Iron Deficiency.

Zambrut.com. Publication date, March 4, 2019. 7

Zambrut.com. Publication date, March 4, 2019. 8

Table 1: Type of anemia in patients

Table 2: Age distribution of iron deficiency anemia patients

Table 3: Measurement of serum ferritin level, severity of iron deficiency anemia

Table 4: Population distribution in iron deficiency anemia

Zambrut.com. Publication date, March 4, 2019. 9

Table 5: Statistical Comparison of Iron Deficiency Anemia

3 DURATION OF IST TRIMESTER (n=91 ) 17.46%

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Zambrut Journal, Link Access;

© Copyright 2019 International Journal of Zambrut | Zambrut, Inc.

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