الفهرس 
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Abstract
Iron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally. Although it is particularly prevalent in less-developed countries, it remains a significant problem in the developed world, even where other forms of malnutrition have already been almost eliminated. Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion. The objective of this guideline is to provide healthcare professionals with clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period. This is the first such guideline in the UK and may be applicable to other developed countries. Public health measures, such as helminth control and iron fortification of foods, which can be important to developing countries.
Iron deficiency represents a spectrum ranging from iron depletion to iron deficiency anaemia. In iron depletion, the amount of stored iron (measured by serum ferritin concentration) is reduced but the amount of transport and functional iron may not be affected. Those with iron depletion have no iron stores to mobilize if the body requires additional iron. In iron-deficient erythropoiesis, stored iron is depleted and transport iron (measured by transferrin saturation) is reduced further; the amount of iron absorbed is not sufficient to replace the amount lost or to provide the amount needed for growth and function. In this stage, the shortage of iron limits red blood cell production and
SUMMARY
results in increased erthryocyte protoporphyrin concentration. In iron-deficiency anaemia, the most severe form of iron deficiency, there is shortage of iron stores, transport and functional iron, resulting in reduced Hb in addition to low serum ferritin, low transferrin saturation and increased erythrocyte proto-porphyrin concentration.
A full blood count is taken routinely in pregnancy and may show low Hb, mean cell volume (MCV), mean cell haemoglobin (MCH), and mean cell haemoglobin concentration (MCHC); a blood film may confirm presence of microcytic hypochromic red cells and characteristic ‘pencil cells’. However, 1-microcytic, hypochromic indices may also occur in haemoglobinopathies. In addition, for 2-milder cases of iron deficiency, the MCV may not have fallen below the normal range.
For pregnant and nonpregnant patients with α- or β-thalassemia, hemolytic anemia caused by ineffective erythropoiesis is the major complication. Imbalanced nonstoichiometric production of a- and b-globin chains leads to disruptions in red cell physiology, causing intramedullary destruction of erythroid precursors and hemolysis of circulating red blood cells. Extra-medullary hematopoiesis occurs when anemia is severe. In an attempt to maintain erythropoietic needs, iron use is increased through reduction in hepcidin levels, leading to hemochro-matosis independent of transfusion therapy. Splenectomy can be helpful in improving anemia but confers an increased risk of thrombosis, particularly in patients with HbE thalassemia.
SUMMARY
Women with thalassemia trait become more anaemic during pregnancy, more so for beta-thalassemia trait. This is usually attributed to the limited ability to increased red cell mass in response to the increased plasma volume. Mean corpuscular volume increases during pregnancy, albeit to a lesser extent (mean volume 2.3 fL v 4.3 fL). Although the incidence of folic acid and vitamin B12 deficiency has been reported to be the same as normal pregnant women, the increased red blood cell turnover possibly requires increased folic acid supplementation. It has been shown that women receiving 5 mg folic acid daily have significantly greater increase in the pre-delivery haemoglobin level compared with women receiving only 0.25 mg daily for both nulliparas and multiparas. Iron supplementation, on the other hand, should be individualized, and is usually unnecessary.
Weekly iron folate supplementation for all menstruating women, including school girls Globally, more than 460 million non-pregnant women (15–49 years) are estimated to be anaemic and two thirds of them will be from Asia .Weekly iron (60 mg of ferrous sulphate) and folic acid (3 mg) supplementation (WIFS) for WRA, including adolescent girls between 10–19 years could be an effective strategy to achieve good iron stores before a woman becomes pregnant. WIFS programmes for WRA have been effective in reducing the prevalence of anaemia in certain districts in Vietnam, the Philippines, and Cambodia. Selecting a fixed day in the week as ‘WIFS Day’ or ‘Iron Day’ could be effective in addressing the problem of forgetfulness and to improve compliance. The duration of supplementation should probably be for at least three months and it should be repeated preferably at six monthly intervals. Iron supplementation may lead to exacerbations of infections, and also malaria in communities with a high prevalence of malaria.