Anemia is a condition where red blood cells are unable to carry adequate oxygen to the body’s tissues to meet the physiological needs of the body⁽¹⁾. This condition can also be defined as lower level of hemoglobin concentration, reduced other hematocrit and number of RBCs (Red blood cells)⁽²⁾. Anemia is a major health problem globally as well as for India, affecting 1.62 billion people out of which 56 million are pregnant women. In pregnant woman i.e. 15-49 years of age, prevalence of anemia is 50.3%. In anemia other than pregnant women, adolescent girls and young children are also at high risk leading to increase numbers of mortality and morbidities.⁽³⁾

Hemoglobin levels to diagnose anemia (g/dl)⁽⁴⁾

There are various types and classifications of anemia. Anemia is due to the various red cell defects such as:

• Production defect – Aplastic anemia
• Maturation defect – Megaloblastic anemia
• Defects in haemoglobin synthesis – Iron deficiency anemia
• Genetic defects of haemoglobin maturation – Thalassemia
• synthesis of abnormal haemoglobin – Hemoglobinopathies, sickle cell anemia and thalassemia)
• Physical loss of red cells – Hemolytic anemia

Dietary recommendation:

Female of child bearing age and pregnant woman are mainly prone to anemia because their body requirement of iron cannot meet from their diet. In pregnant women daily requirement of iron in last three months of pregnancy is 30mg/day but our Indian diet cannot fulfill this need. So dietary modifications like inclusion of green-leafy vegetables, meat and poultry, iron fortified foods also including the enhancer (e.g. Vit C) and excluding the inhibitors (e.g. coffee) is necessary step.

Iron prophylaxis:

Only proper diet and appropriate nutrition is unable to give satisfactory results. So with the help of dietary modifications iron supplementations are also necessary. These prophylactic measures plays important role in restoring and maintaining adequate iron load in deficient population. So Anemia Mukt Bharat Guidelines have given some recommendation of iron supplements. Use recommendations given by Anemia Mukt Bharat Guidelines)

Prophylactic dose and regime for Iron Folic Acid supplementation

Treatment

Oral

So recommended dose of elemental iron for IDA in pregnancy is between 100- 120mg/day according to WHO guidelines.⁽¹⁾ Increasing dose beyond this dose leads to increased gastrointestinal side effects like bloating, diarrhea, heartburn, nausea, constipation, and dark stools without improvement of efficacy. For better absorption oral iron therapy should take empty stomach or preferably with vitamin C rich product such as orange juice or guava.

Parenteral

Parental iron (IV Iron Sucrose) may be considered as the first line of management in pregnant women who are detected to be anemic late in pregnancy or in whom compliance is likely to be low. For the severe anemia (Hb 5.0-6.9g/dl) the treatment will be done using IV Iron Sucrose Intravenous iron therapy having the advantage of less gastro intestinal (GI) side effects and speedy recovery of Hb than oral iron therapy

Parenteral iron therapy plays important role when there is need of rapid repletion of iron stores. The most common iron preparation which is used for anemia in pregnancy was iron sucrose complex. (ICS). It is not associated with anaphylaxis and other adverse reaction but this needs multiple doses and prolonged infusion time. That is the main disadvantage of iron sucrose.

The new addition in i.v. iron preparations is Ferric Carboxymaltose (FCM), which is a dextran free type I iron complex. IV ferric carboxymaltose (FCM) has a neutral pH (5.0‑7.0) and physiological osmolality, because of this it is possible to administer in higher single doses over shorter time periods (single dose up to 1000 mg over 15 min) than other parenteral preparations. Also it does not contain dextran; therefore, the risk of anaphylaxis or serious hypersensitivity reactions is very low.