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Dr. Andrew Rynne

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Pregnant. Suggested for orofer s iv injection. Am I anemic?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

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Posted on Tue, 26 Mar 2013 in Pregnancy
Question: am 21 weeks pregnant with hemoglobin 9.1,doctor advised me to take orofer s I.V.,is it required at all,am i that anaemic?am Indian,aged 44yrs.
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Answered by Dr. Aarti Abraham 57 minutes later
Hello XXXXXXX
Thanks for your query.

WHO has accepted up to 11gm% as the normal hemoglobin level in pregnancy. However in India and most of the other developing countries, the lower limit is often accepted as 10 gm %.

During pregnancy, the demand for iron and other vitamins is increased. In order to have enough red blood cells for the fetus, the body starts producing more red blood cells and plasma. It has been calculated that the blood volume increases approximately 50% during pregnancy, although the plasma increase is disproportionately greater. This causes a dilution of the blood, making the hemoglobin concentration fall. This is a normal process, with the hemoglobin concentration at its lowest between weeks 25 and 30. Other causes of anemia in pregnancy include - Vegetarian diet with less greens, Lack of iron in diet, Lack of folic acid in diet, Lack of vitamin B12.

As you can see, you are only 21 weeks pregnant, so the anemia is expected to worsen during the third trimester.

National nutritional anemia prophylaxis program advises supplementation of 60 mg elemental iron and 500 mcg of folic acid daily for 100 days to all pregnant women. However it is suggested that 120 mg of elemental iron and 1 mg folic acid are the optimum daily doses needed to prevent anemia in pregnancy.

The main aim is to reverse the anemia and to build sufficient iron stores in the body. Oral therapy is the first line of treatment. If the patient is unable to tolerate oral medications parenteral therapy is opted. Transfusion is indicated in cases with severe symptoms. Most patients with mild to moderate anemia respond to treatment within 2-3 months. In order for symptoms to subside, the body must restore the loss in RBCs. It takes about 5-6 days for the body to produce new RBCs after supplementation. By 2-3 weeks the hemoglobin level increases. Only then the symptoms will subside.

I would recommend a trial of oral iron first. You need to sincerely take the supplements, maybe twice a day. Oral iron has its own intolerance and side effects, like gastritis, indigestion, flatulence, constipation or diarrhoea.. and if you are unable to tolerate them, you can then go for IV iron therapy. Make sure you take the tablets on an empty stomach, and alongwith vitamin C for better absorption.

ALso get yourself screened for folate and B 12 deficiency, thalessemia, worm infestation in stool etc. as these are also causes for refractory anemia.

Improve greatly on your diet also - include red meat, liver, protein, egg, XXXXXXX leafy vegetables, broccoli, spinach, vitamin C etc.

Take care and feel free to discuss further.
Be well.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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