2.10.2.1. Ferritin <30ng/mlmcg/L indicates iron depletion. If there are suspected issues around compliance, encourage patients to take iron medication. Their GP may be able to prescribe an alternative oral iron therapy e.g. ferrous fumarate 200mg. If poor compliance, intolerance due to side effects, or poor absorption is suspected, the pregnant person may require Ferinject.
2.10.2.2. Low vitamin B12 level is hard to interpret as the assay used in RCHT often gives low levels in pregnant patients without there being a genuine deficiency. If B12 level is low, then it is reasonable to treat, i.e. one single dose of IM Hydroxocobalamin 1 mg. However, this is not a confirmed diagnosis of vitamin B12 deficiency and the GP needs to be asked to follow up testing in the postpartum period.
2.10.2.3. Low folate level is usually due to dietary insufficiency, though it can be due to malabsorption. Treat with 5mg/day of Folic acid and recheck FBC and folate in 6-8 weeks.
2.10.3.1. Post natal anaemia is associated with maternal reduced cognitive ability, depression, and emotional instability.
2.10.3.2. Hb >120g/L should be considered an optimal haemoglobin level. Ferritin is an acute phase protein so levels may be raised following delivery which makes it less reliable than in the antenatal period. It is therefore not checked routinely.
2.10.3.3. Check FBC on day 1:
For all women who have had a LSCS.
PPH of more than 500ml.
Uncorrected anaemia in the antenatal period.
■ Known iron deficiency anaemia.
■ Any woman with symptoms/signs suggestive of anaemia.
2.10.3.4. Hb >120g/L: no iron supplementation or further blood tests.
2.10.3.5. Hb 100-120g/L and asymptomatic and haemodynamically stable. Offer alternate day oral iron for 3 months. Advise the woman to have a repeat FBC and ferritin after 6 weeks to ensure Hb and iron stores are replete.