Haemoglobin less than 105g per L obstetric management

If Hb <105g/l, check

• FBC and blood film
• Serum ferritin

If ferritin <50, commence oral replacement therapy

• commence ferrous fumarate 210mg tid (contains 68mg elemental iron per tablet), 2^nd line management ferrous sulphate 200mg tid to be used only when ferrous fumarate not available

If ferritin >50, 

• Consider other causes of anaemia
• If strong clinical suspicion of iron deficiency anaemia, consider checking serum iron and transferrin.

 Monitor Response

• Check FBC every 4 weeks after commencing therapy
• Hb level may take up to 6 weeks to respond
• Check reticulocyte count if no response in Hb after 4 weeks – this will increase prior to rise in Hb and will indicate that RBC production is responding to therapy
• If no response in reticulocyte count at 4 weeks, review diagnosis
• Monitoring of response may need to be more frequent if anaemia treatment does not commence until the late second or third trimester
• Haematinic replacement should continue until at least 6 weeks post partum, longer if significant post partum haemorrhage occurs
• If iron deficiency is confirmed and there is no response to oral iron replacement or oral iron cannot be tolerated, intravenous iron may be used.