IRON DEFICIENCY

ANEMIA
Consultant in charge : dr. Edy Priyanto, Sp,OG, Subsp. F.E.R,
M. Kes

Name/Age/ Consultant in
Diagnosis Management Complication Transfer
Medrec Charge
Mrs. Desti G4P3A0 40 y.o 28 weeks 6 Conservative Premature Flamboyan EP
Purbarini days of pregnancy; management contraction; Ward
40 y.o premature contraction; microcytic
00819371 microcytic hypochromic hypochromic
anemia (9.2); asymptomatic anemia (9.2);
bacteriuria; advanced asymptomatic
maternal age bacteriuria;
advanced maternal
age

Visi Program Studi Pendidikan Dokter Spesialis I Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjadjaran/ RS Dr. Hasan Sadikin Bandung:
Program studi Obstetri dan Ginekologi dapat Menjadi institusi pendidikan dokter Obstetri dan Ginekologi yang unggul dan mampu bersaing secara global pada tahun 2024.
◦ According to Basic Health Research (Riskesdas), 73.2% of pregnant women received blood supplement
tablets (TTD), but the incidence of anemia in pregnant women increased from 37.1% (Riskesdas 2013),
to 48.9% (Riskesdas 2018).
◦ Iron deficiency anemia is the most common anemia in pregnancy. According to WHO, almost 2 billion
people worldwide suffer from iron deficiency, and up to 50% of them are pregnant women
 Anemia
WHO  Anemia in pregnancy : Hemoglobin <11 g/dL or hematocrit (Ht) <33%
Postpartum anemia : Hemoglobin <10 g/dL
CDC  Hemoglobin <11 g/dL in the first and third trimesters
Hemoglobin <10.5 g/dL in the second trimester
Hemoglobin <10 g/dL postnatal
 ANEMIA IN PREGNANCY

Anemia is a reduced concentration of

Decreased Hb and erythrocytes or hemoglobin in the blood
Hct levels during
pregnancy Prevalence:
Global → 41,8%
ANEMIA IN PREGNANCY Southeast Asia → 40-
75%
Caused by the
expansion of the
plasma volume which Most common cause of
is relatively greater CDC WHO anemia:
than the RBC volume 1. Iron deficiency anemia
2. Acute blood loss
Hb < 11 g/dL in the 1st Hb < 11 g/dL
and 3rd trimester
Hb < 10.5 g/dL in the
2nd trimester

20. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2).
21. Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Catherine Y S, Casey BM. Williams Obstetrics. 2022. 1078 p.
Iron deficiency anemia
WHO
◦ Condition where the body lacks iron
◦ As evidenced by signs of iron deficiency in the tissues and insufficient iron reserves in the body
◦ Accompanied by a decrease in hemoglobin levels of more than 2 standard deviations from the reference
value in the same population
◦ Iron deficiency anemia is currently the most common cause of anemia in pregnancy
Iron deficiency anemia
◦ Hypochromic microcytic erythrocytes
◦ Stages:
1. Iron depletion (decreasing iron reserves)
2. Iron deficiency erythropoiesis (decreased iron reserves and transport)
3. Iron deficiency anemia (low reserves, iron transport and functional iron).
 MANAGEMENT OF IRON DEFICIENCY ANEMIA

Clinical practice recommendations for

managing iron deficiency anemia with
hemodynamically stable in the emergency
department using red blood cell
transfusions, intravenous iron, or oral
iron

This algorithm is used to assess the

appropriateness of red blood cell
transfusion in the ED and candidacy for
iron supplementation

26. Spradbrow J, Lin Y, Shelton D, Callum J. Iron deficiency anemia in the emergency department: Over-utilization of red blood cell transfusion and infrequent use of iron supplementation. Can J Emerg Med. 2017;19(3):167–74.
Iron
Daily iron requirements (mg)

1st Trimester 18

2nd Trimester 27

3th Trimester 27
 DIAGNOSIS AND MANAGEMENT OF IDA IN PREGNANCY

IN THIS CASE

The diagnosis of anemia was made

after a routine blood test which
showed hemoglobin level of 9.1
mg/dl and hematocrit of 28%

Confirm the diagnosis of anemia

in pregnancy because it complies
with the definition of anemia in
pregnancy according to
WHO and CDC

25. Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: Iron, cobalamin, and folate. Blood. 2017;129(8):940–9.
Supporting investigation :
1. Hemoglobin concentration (Hb)
2. Count erythrocytes Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
3. Red-cell Distribution Width (RDW)
4. Reticulocytes Reticulocyte Hemoglobin Content (Ret-He/CHr)
5. Ferritin Serum Iron (SI) and Total Iron Binding Capacity (TIBC)
6. Transferrin receptor/soluble transferrin receptor (sTfR)
7. Transferrin Saturation (TSAT)
8. Microcytic/hypochromic ratio (MCV/MCH)
9. Hepcidin
 DIAGNOSIS OF IDA IN PREGNANCY

Initial evaluation of a
pregnant woman with
anemia includes:

- Hemoglobin
- Hematocrit
- Red blood cell index
- Serum Fe/serum ferritin
- Peripheral blood smear
examination
Interpretation of laboratory evaluation results

21. Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Catherine Y S, Casey BM. Williams Obstetrics. 2022. 1078 p.
23. Georgieff MK. Iron deficiency in pregnancy. Am J Obstet Gynecol [Internet]. 2020;223(4):516–24. Available from: https://doi.org/10.1016/j.ajog.2020.03.006
24. Frayne J, Pinchon D. Anaemia in pregnancy. Aust J Gen Pract. 2019;48(3):125–9.
 Diagnosis

HKFM POGI. Anemia dalam Kehamilan. 2023

 Diagnosis

HKFM POGI. Anemia dalam Kehamilan. 2023

 Treatment
Ferritin
- Ferritin 70–80 μg/L: It is estimated that iron reserves in the body are more than 500 mg, so no
supplementation is necessary.

- Ferritin 30–70 μg/L: Estimated iron reserves in the body are 250–500 mg, so supplementation with
30–40 mg of elemental iron is recommended.

- Ferritin <30 μg/L: It is estimated that iron reserves in the body are low enough that supplementation
with 60–80 mg of elemental iron is required.
 Treatment
In mild iron deficiency anemia with Hb levels of 10–10.4 g/dL, oral iron therapy of 80–100 mg/day
can be given. If pregnant women are diagnosed with iron deficiency anemia in the first and
second trimesters, oral iron tablets can be given as first-line therapy.
Treatment
 Treatment
● Oral iron preparations can be salt preparations, slow release, iron-polysaccharide complexes, and
carbonyl iron. Ferrous sulfate, ferrous fumarate, and ferrous gluconate are iron salt preparations. One
of the iron salt preparations that is more often used in Indonesia is ferrous sulfate, because it is easier
to obtain and the price is more affordable.
● Therapy evaluation: 2-3 weeks post therapy and monitoring every trimester
 Complications
● Mild: Maternal
● Moderate – severe: Maternal – Placenta – Fetal

● Maternal: Antepartum hemorrhage

Post partum hemorrhage
Blood transfusion
Risk of infection
Preeclampsia
Risk of cardiovascular disease

● Placenta: Triggers placental angiogenesis

Triggers placental hypertrophy
Increased capillarization for increased placental vascularization
● Fetus: Preterm birth
low birth weight baby
impaired fetal growth
IUFD
Thank you