Anemia in the inpatient settings: what is left out of sight
Authors: Zhuk S.I. , Antoniuk Ye.S. 
Published: July 2021

Background. Anemia is a decrease in the number of erythrocytes and hemoglobin levels as a result of blood loss, disruption of erythropoietic cell production, and increased erythrocyte breakdown or a combination thereof. Anemia of pregnant women is divided into physiological anemia and pathological conditions. In case of latent iron deficiency clinical manifestations are absent. This condition is characterized by a decrease in iron and erythropoietin to a level sufficient to maintain hematological parameters at the lower limit of normal values. In the absence of iron supplements administrations 65 % of cases of latent deficiency end up in a manifest deficiency.

Objective. To describe the features of the anemia treatment in inpatient settings.

Materials and methods. Analysis of literature sources on this issue.

Results and discussion. The normal value of hemoglobin for the 1st and 3rd trimesters is ≥110 g/l, for the 2nd – ≥105 g/l. After childbirth, anemia is determined as a decrease in hemoglobin <100 g/l. Risk factors for anemia in pregnant women include poor nutrition, chronic diseases, chronic intoxication, history of anemia, bleeding during pregnancy, multiple pregnancy, frequent childbirth with a long lactation period, and short intervals between births. Anemia in pregnant women increases the probability of premature birth by 63 %, of low birth weight – by 31 %, of perinatal mortality – by 51 %, of neonatal death – in 2.5 times. In case of maternal anemia, the newborn has a worse development of external respiratory function, a lag in the weight gain and a greater susceptibility to infectious diseases. To diagnose anemia, a general blood test and determination of additional indicators (serum iron, ferritin, ferritin saturation, transferrin, soluble ferritin receptor) are used. Patients with mild anemia do not require hospitalization; patients with moderate anemia need hospitalization in the absence of a response to oral iron supplements; patients with severe anemia need hospitalization after the mandatory consultation of hematologist. The purposes of anemia treatment include the normalization of blood tests, correction of iron deficiency, and the creation of iron stores to ensure full fetal development and lactation. Evaluation of treatment is performed on the 21st day after treatment; normally the increase in hemoglobin is about 1 g per 1 day of therapy. If hemoglobin has increased by <10 g/l, it is advisable to prescribe intravenous iron. Indications for parenteral administration also include the intolerance to oral iron supplements, peptic ulcer disease in the exacerbation phase, lack of confidence in the good adherence of the patient, hemodialysis, swallowing disorders, and the need for a more pronounced increase in hemoglobin. If it is necessary to quickly restore the level of blood hemoglobin in the late stages of pregnancy, Sufer (“Yuria-Pharm”) can be administered (10.0 ml in 200.0 ml of saline intravenously 1-3 times a week). Parenteral administration of iron supplements should be administered with caution in case of polyvalent allergies, active infections, chronic liver disease, and signs of iron overload. Parenteral administration of iron supplements is not indicated in the 1st trimester of pregnancy.

Conclusions. 1. Anemia in pregnant women increases the likelihood of premature birth, low birth weight, perinatal mortality, and neonatal death. 2. The purposes of anemia treatment are the normalization of blood tests, correction of iron deficiency and the creation of iron stores. 3. Indications for parenteral administration of iron are lack of response and intolerance to oral iron supplements, exacerbation of the peptic ulcer disease, and the need for a more pronounced increase in hemoglobin. 4. If it is necessary to quickly restore the level of hemoglobin in the late stages of pregnancy, Sufer may be prescribed.