So far we have a women who is 11 weeks pregnant and feeling tired and out of sorts. She has a microcytic anaemia and a borderline platelet count. Firstly let’s think about the anaemia. The two most common causes of anaemia in pregnancy are:

• Iron deficiency
• Haemoglobinopathy

Anaemia is exacerbated in pregnancy due to:

• Increase in red cell mass
• Blood loss
• Increased maternal iron requirements
• Iron needed by foetus and placenta
• Dilution – increase in plasma volume

The MCV increases in pregnancy usully by 6Fl by about 26 weeks, so to have a microcytic picture would be unusual during pregnancy unless the patient has significant iron deficiency or a pre-existing haemoglobinopathy.

Questions:

• What would you want to know before starting iron supplementation?
• Are there any risks to iron supplementation?
• When would you consider intravenous iron?
• Which women are at risk of iron deficiency during pregnancy?
• Why should iron be replaced? What are the risks of not replacing?

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