UK guidelines on the management of iron deficiency in pregnancy

Pavord, Sue; Daru, Jahnavi; Prasannan, Nita; Robinson, S.; Stanworth, Simon J; Girling, Joanna

doi:10.1111/bjh.16221

Cited by 309 publications

(565 citation statements)

References 86 publications

(95 reference statements)

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“…It is hoped that as clinicians get more comfortable with managing anaemic women for short periods of time while their haemoglobin increases, the transfusion thresholds may improve. 10 The results of our intervention are less dependent on education than the antenatal haemoglobin optimisation interventions.…”

Section: Lessons and Limitationsmentioning

confidence: 92%

“…However, obstetric management guidelines recommend screening pregnant women for anaemia with a FBC only and do not suggest universal screening with ferritin or universal iron replacement in high income countries. [10][11][12] This is despite prior work demonstrating the potential to reduce transfusion with antepartum identification and management of iron deficiency. 16 The prevalence of iron depletion is high in young women and pregnancy, particularly during the third trimester when there is an additional strain on iron stores.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

“…Obstetric guidelines from developed countries generally recommend screening for anaemia with haemoglobin measurement alone. [10][11][12] Organisations following recommended guidelines will only be detecting iron deficiency if anaemia develops before routine antenatal testing, which in most cases is completed by 24-26 weeks gestation. Non-anaemic iron deficiency and anaemia developing after this time is not routinely screened for or treated.…”

Section: Introductionmentioning

confidence: 99%

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Improving patient blood management in obstetrics: snapshots of a practice improvement partnership

Flores

Sethna

Stephens

et al. 2017

BMJ Qual Improv Report

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Iron deficiency and anaemia are common in pregnancy. Audit data from our tertiary obstetrics unit demonstrated 22% of maternity patients experiencing a postpartum haemorrhage received a transfusion; a third of whom were anaemic on admission intrapartum. Australian Patient Blood Management (PBM) Module 5 Obstetrics guidelines focuses on maximising red cell mass at the time of delivery and reducing the reliance on transfusion as a salvage therapy to treat blood loss. A clinical practice improvement partnership began in February 2015 and completed in April 2016; which aimed to implement systems to improve antenatal identification and management of iron deficiency, and improve postpartum anaemia management. In order to develop change strategies, reasons for poor detection and correction of iron deficiency in the antenatal period were identified following a quality improvement methodology. Education was delivered to maternity healthcare providers. Standardised algorithms and an oral iron prescription handout were developed and piloted. Follow-up audit, staff and patient feedback, and other hospital data were collected to measure outcomes. The rate of anaemia on admission intrapartum fell from 12.2% in 2013 to 3.6% in 2016 following the introduction of unselective ferritin screening and other antenatal interventions. Sixty to 70% of maternity patients screened each month had iron deficiency. The algorithms aided staff to become confident in blood test interpretation and management of iron deficiency and anaemia. Patients found the oral iron prescription handout helpful. Additionally, single unit transfusions significantly increased from 35.4% to 50% (p=0.037) over the project timeframe. This project demonstrated the potential to improve patient blood management in obstetrics, reduce anaemia and transfusions by active antenatal interventions.

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Section: Lessons and Limitationsmentioning

confidence: 92%

Section: Lessons and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improving patient blood management in obstetrics: snapshots of a practice improvement partnership

Flores

Sethna

Stephens

et al. 2017

BMJ Qual Improv Report

View full text Add to dashboard Cite

show abstract

“…Whereas prospective outcome data on iron supplementation are lacking, given the very high safety profile of medicinal iron, irrespective of the route of administration, one could posit erring on the side of repletion and screening would be more prudent. Supporting this recommendation is a recently published study, referenced in the manuscript which is the subject of this editorial (Pavord et al , ), of 104 consecutive, non‐selected, non‐anaemic, first trimester gravidas who were screened for iron deficiency with tests for serum ferritin and percent transferrin saturation (Auerbach et al , ). Based on either serum ferritin or transferrin saturation, 42% were deficient, suggesting that the recommendations of the USPSTF should be revisited, moving towards a more aggressive paradigm of screening and treatment, to mitigate statistically significant negative outcomes in infants born with iron deficiency.…”

mentioning

confidence: 99%

Guidelines for iron deficiency in pregnancy: hope abounds

Auerbach

Georgieff

2019

Br J Haematol

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“…The mechanisms of IDA differ between developed and underdeveloped countries and between the groups at risk in developed countries. More details on these aspects are available elsewhere . IDA can be determined by standard laboratory testing and the extent of the iron deficit measured using the Ganzoni formula (iron deficit [mg] = patient weight (kg) × (target – actual hemoglobin [Hb]) × 2.4 + 500) or a derivative of this formula .…”

mentioning

confidence: 99%