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Am I suffering from anaemia?

Q: I am a 27 years old female into my 28th week of pregnancy. My haemoglobin was low (9.7) and so, I started taking Haemplus twice a day but it didn’t help much. Then the doctor prescribed me Feroglobin twice a day along with iron in the form of drip but then too my Hb is 9.9. Why isn’t my Hb level improving? Am I suffering from anaemia?

A:Anemia is a condition in which the number of red blood cells (RBCs) or the amount of hemoglobin (Hb) is below normal for age and sex of the individual. It is usually discovered and quantified by measurement of the RBC count, hemoglobin (Hb) concentration, and hematocrit (Hct). Anemia is suggested in pregnant women with Hb levels less than 11.5 g/dl. The most common cause of anemia in pregnancy is deficiency of iron (~85% cases) and folic acid. Even if a woman is not anemic at the time of pregnancy, she may still develop anemia as the pregnancy progresses due to several reasons. The fluid content of the blood (blood volume) increases upto 50% while the red cells increase by only about 20-30% resulting in haemodilution i.e. relatively fewer red cells (& Hb) present in an increased volume of blood. There is also increased demand of the developing baby which depletes the mother’s iron stores. There are certain risk factors for women being anemic and these include: poor nutrition, inadequate gap between pregnancies, persistent nausea or vomiting in early pregnancy and twin pregnancy. The loss of iron (elemental) with each normal menses is around 12-15 mg. A normal diet must include 1.5-2 mg/day of elemental iron to compensate for menstrual losses alone. In pregnancy, 500 mg of additional iron is needed by the mother (to expand her red cell mass) while another 500 mg is needed for the baby and placental tissues. Thus, on an average, an additional 3 mg/day of elemental iron must be absorbed from dietary sources. The amount of iron absorbed by the body is only 10% of the total amount consumed, thus 30 mg/day needs to be consumed to meet the requirement. The developing baby needs iron, folic acid and vitamin B12 from the mother for its growth. Women thus need to take supplemental iron and folic acid to meet the needs of the baby and hence iron deficiency is very common. If supplemental iron is not added to the diet, iron deficiency anemia will result. Maternal requirements can reach 5-6mg/day in the latter half of pregnancy. If iron is not easily available, the baby uses iron from maternal stores. Thus, the production of fetal hemoglobin is usually adequate even if the mother is severely iron deficient. This maternal iron deficiency may cause preterm labour and late spontaneous abortion. Deficiency of folic acid and vitamin B12 may also be seen in individuals on purely vegetarian diet. An iron deficient mother can have premature labour, intrauterine growth retardation (poor development of baby), severe anemia due to normal blood loss during delivery and increased susceptibility to infection. The likelihood of postpartum transfusion may be reduced if a woman enters the birth with a higher hemoglobin level. Please get a complete blood count, reticulocyte count and a peripheral blood film examination done, which will help, in finding the underlying cause. Giving iron by injection has its own problems and should be used as a last resort. Make sure you are taking an adequate dose, not taking other food items along with iron that hamper its absorption, not having chronic blood loss etc. Please consult a haematologist who can examine you and advise.

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