FOLLOW SUGGESTIONS.....
Each ml of blood contains approximately 0.5mg of iron & as such a unit of donated blood of 350ml contains 175 mg of iron & so..
A 30 to 40 ml blood (Normal blood loss during physiological blood losses of mensturation) each & every month is saved in pregnancy because of amenorrhea of pregnancy
that means for 9 months she saves 270ml to 360ml of blood equal to 135mg to 180mg of iron.
So on one hand a unit of blood in 9 months is saved.
But on the other hand the requirements are tremendously high as atleast 1000mg iron is required for the growing fetus & placenta.
It means 1000 mg if as each unit is 200mg or 4 units of blood are required during each pregnancy.
Starting iron at the end of first trimester is ideal as iron requirements begin to increase at this stage.
Iron rich diet is equally helpful but elemental iron is ideal alternative.
Role of folic acid & B12 even in pre-conception period must never be ignored & continued till organogenesis is complete for the growing fetus.
As a routine 1000 mg of iron is required during each pregnancy or 100 tablets of iron during pregnancy.
Excluding twin,Triplet & so..
Management of iron deficiency anemia in pregnancy is challenging but new iron preparations have made it little easier as iron sucrose 300mg three times a week or 900mg per week or Ferric Carboxymaltose 1000mg single dose once a week is helpful but at certain times pre pregnancy status may be so low that 2000mg of iron transfusions may not be sufficient.
Most of patients report too late & as late as 34 weeks onwards .
Only choice remains-the blood transfusions & no transfusion is good unless alternative to transfusions work.
Although newer iron are too safe but transfusions be requested at hospital & under supervision.
The oral sucrosomial or lyposomial iron or other tolerable iron if started at earliest as indicated till desired effects are reached is the best solution but cooperation & compliance is must.
Utmost care is required from each & everyone from parents,relationships, doctors & so on..
Besides at least 10 days iron be prescribed (which ever type or salt of iron is tolerable) in every woman in her reproductive age group in every month to replace the physiological blood losses.
Dr Javaid Iqbal Khan
Senior Hematologist at LD Hospital