FBC and ferritin should be routinely checked at booking and 28 weeks. They can also be tested at any point in pregnancy if a patient is symptomatic of anaemia.

2.9.2.1. If the Hb at booking is <120g/L and ferritin <150mcg/L: Start on trial of oral iron: Ferrous Sulphate 200mg or Ferrous Gluconate 300mg on alternate days

2.9.2.2. If booking Hb <120g/L, but ferritin is >150-300mcg/L, the patient may have a reason for anaemia other than iron deficiency. Seek obstetric advice and consider other causes of anaemia. Take folate and B12 bloods prior to referral.

2.9.2.3. If booking Hb >120g/L, but ferritin is <30mcg/L, the patient is iron deficient, and at high risk of developing anaemia even though her Hb is currently normal. Start on oral iron therapy and recheck FBC and ferritin after 6 weeks following the same advice as in 2.8.2.2.

2.9.2.4. Hb <70g/L: Urgent referral to joint Haematology Obstetric clinic to investigate and plan management. Do not offer blood transfusion unless symptomatic or currently bleeding.

2.9.2.5. If booking Hb > 120g/L and ferritin is above 30 then this can be rechecked at 28 weeks. No oral iron is needed at this stage. However, the woman should be encouraged to ensure a well-balanced diet.

2.9.2.6. Ferinject is contraindicated in the first trimester.

2.9.2.7. If Ferritin is >300mcg/L then refer to GP for advice.

2.9.2.8. Once oral iron has been started then monitor for side effects and poor compliance. If any issues, then change iron preparation. Consider ferrous fumarate from GP as an alternative if Sulphate and Gluconate have been tried. Recheck in 6 weeks.

2.9.2.9. At 6 week recheck, if Hb is less than at booking then check if compliance has been good and if alternative preparations have been tried. Refer to consultant obstetrician if alternative preparation has been trailed and compliance is good. Refer to section 2.4 for advice on compliance, dose intervals, when to take drug, what to take drug with etc. Ensure woman has leaflet on iron deficiency and anaemia.