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æåëåçîäåôèöèò âî âðåìÿ áåðåìåííîñòè - áðèòàíñêèå ðåêîìåíäàöèè 2011
Summary of key recommendations
Anaemia is defined by Hb <110g/l in first trimester, <105g/l in second and third trimesters and <100g/l in postpartum period Full blood count should be assessed at booking and at 28 weeks All women should be given dietary information to maximise iron intake and absorption Routine iron supplementation for all women in pregnancy is not recommended in the UK Unselected screening with routine use of serum ferritin is generally not recommended although individual centres with a particularly high prevalence of “at risk” women may find this useful For anaemic women, a trial of oral iron should be considered as the first line diagnostic test, whereby an increment demonstrated at two weeks is a positive result Women with known haemoglobinopathy should have serum ferritin checked and offered oral supplements if their ferritin level is <30 ug/l Women with unknown haemoglobinopathy status with a normocytic or microcytic anaemia, should start a trial of oral iron (1B) and haemoglobinopathy screening should be commenced without delay in accordance with the NHS sickle cell and thalassaemia screening programme Non-anaemic women identified to be at increased risk of iron deficiency should have a serum ferritin checked early in pregnancy and be offered oral supplements if ferritin is <30 ug/l Systems must be in place for rapid review and follow up of blood results Women with established iron deficiency anaemia should be given 100- 200mg elemental iron daily. They should be advised on correct administration to optimise absorption Referral to secondary care should be considered if there are significant symptoms and/or severe anaemia (Hb<70 g/l) or late gestation (>34 weeks) or if there is failure to respond to a trial of oral iron. For nausea and epigastric discomfort, preparations with lower iron content should be tried. Slow release and enteric coated forms should be avoided Once Hb is in the normal range supplementation should continue for three months and at least until 6 weeks postpartum to replenish iron stores Non-anaemic iron deficient women should be offered 65mg elemental iron daily, with a repeat Hb and serum ferritin test after 8 weeks Anaemic women may require additional precautions for delivery, including delivery in a hospital setting, available intravenous access, blood groupand- save, active management of the third stage of labour, and plans for excess bleeding. Suggested Hb cut-offs are <100g/l for delivery in hospital and <95g/l for delivery in an obstetrician-led unit Women with Hb <100g/l in the postpartum period should be given 100- 200mg elemental iron for 3 months Parenteral iron should be considered from the 2nd trimester onwards and during the postpartum period for women with confirmed iron deficiency who fail to respond to or are intolerant of oral iron Blood transfusion should be reserved for those with risk of further bleeding, imminent cardiac compromise or symptoms requiring immediate attention. This should be backed up by local guidelines and effective patient information [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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