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Question answered:01/05/08
The PatientPlus website contains an article on anaemia in pregnancy and in which it states:
“The Royal College of Obstetricians and Gynaecologists advise that women should be offered screening for anaemia at booking and at 28 weeks gestation.1 Hb ≤10.5g/dl and serum ferritin and mean cell volume low indicate iron deficiency anaemia and this accounts for 85% of all cases of anaemia that are identified.
Uncommon causes:
• Folic acid deficiency
• Sickle cell disease
• Haemoglobin SC
• Beta thalassaemia (more common in patients from South East Asia, Southern Europe and Africa)
• Vitamin B12 deficiency
• Chronic haemolysis (hereditary spherocytosis)
• Paroxysmal nocturnal haemoglobinuria
• Leukaemia
• GI bleeding.”
In the section on investigations, it notes:
“Investigations
• Hb ≤ 11.0g/dl
• MCV (mean cell volume): if ≤ 76fl then probable cause is iron deficiency, but if lower than concomitant with other signs of anaemia and RBC count raised, then suggests possible B2-thalassaemia (estimate HbA2 and use Hb electrophoresis).
• Normal MCV (76-96fl) with low Hb is typical of pregnancy.
• Serum ferritin 10-50g/dl needs monitoring and <10g/dl requires treatment. “ [1]
A second PatientPlus article, one on antenatal care discusses folic acid supplementation:
“Supplementation with folic acid is one of the most significant interventions available. 400mcg/day for all women has been shown to reduce the incidence of neural tube defects (NTD), such as spina bifida, by 72%.
Women who have already given birth to a child with a NTD, or who are at a higher risk should be prescribed 5mg/day. Higher risk of NTD is associated with coeliac disease, family history of NTD or anti-epileptic medication. This dose is also recommended for women with diabetes ( type 1 or 2) and sickle cell anaemia.” [2]
For the treatment of folate-deficient megaloblastic anaemia, the BNF offers the following prescribing information:
“Dose
Folate-deficient megaloblastic anaemia, by mouth, ADULT and CHILD over 1 year, 5 mg daily for 4 months (until term in pregnant women); up to 15 mg daily may be required in malabsorption states; maintenance, 5 mg every 1–7 days; CHILD under 1 year, 500 micrograms/kg daily for up to 4 months; maintenance 500 micrograms/kg every 1–7 days …” [3]
References
1. PatientPlus (Mentor). Anaemia in pregnancy. November 2007 (http://www.patient.co.uk/showdoc/40000289)
2. PatientPlus (Mentor). Antenatal care. November 2007. (http://www.patient.co.uk/showdoc/40000185)
3. BNF 55. March 2008. (http://www.bnf.org.uk/bnf/bnf/55/4907.htm?q=%22folic%22%22acid%22)
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