Doses of iron in prevention and treatment of anemia in pregnant women: an ongoing debate

Iron supplementation during pregnancy, both as a preventive and therapeutic measure has been a matter of debate. The guiding principles behind supplementation include availability of adequate iron stores before pregnancy, diet during pregnancy and concomitant infections. No country performs routine screening of iron stores by measuring ferritin and the decision to supplement iron is largely based on haemoglobin (Hb) levels. Evidence suggests that Hb content of the mother’s blood between 95 and 105 g/l in the third trimester correlates with the best clinical outcome. Effectiveness of routine iron supplementation during pregnancy for improving maternal hematological indices exists, but the clinical significance for both pregnant women and infants remains unclear. In the absence of conclusive evidence, several developed nations follow an individual based approach by evaluating the iron stores and then deciding on the course of treatment. On the other hand, in developing countries, where the baseline prevalence of anemia is high, existing data supports routine iron supplementation as a safe strategy to prevent maternal anemia. Controversies exist around the most appropriate dosage and frequency (daily v/s weekly) of iron supplementation for both preventive and therapeutic purposes because increased doses does not necessary yield better haematological and clinical outcomes. On the contrary, excess doses may be associated with more side effects and also may produce oxidative stress, release of free radicals, may interfere with the absorption of divalent cations, may block iron absorption by upregulating hepcidin and may result in hemoconcentration further leading to adverse outcomes. This document gives a snapshot of the existing evidence and provides a case for further deliberations on the most appropriate dosage for iron supplementation during pregnancy giving due weightage to epidemiological, physiological and clinical requirements.

Diagnostic efficacy of digital hemoglobinometer (TrueHb), HemoCue and non invasive devices for screening patients for anemia in the field settings- a proposal

It is important to diagnose anemia at an early stage for appropriate and timely management. There is a need to have a device with good diagnostic accuracy, that is reliable and less expensive. Several methods are available for estimation of Hb. These have been reported to be piloted in small settings with encouraging results. However, for the purpose of screening at the national and state levels, we need a method that has high validity and is cost effective. Our study proposes to establish the diagnostic accuracy of some such devices that are available in India against automated analyzers (gold standard) for screening of anemia in laboratory and community settings.