[Current aspects of diagnosis and therapy of iron deficiency anemia in pregnancy].
Anaemia is one of the most common risk factors in the area of obstetrics and perinatal medicine. During pregnancy and in the puerperium it is associated with an increased incidence of both maternal and fetal morbidity and mortality, the extent of which is dependent upon the severity of anaemia and the resulting complications. In order to correctly diagnose the type and degree of anaemia, a prerequisite for selection of the proper therapy, one must first of all correctly differentiate between the relative, i.e., the physiological anaemia of pregnancy due to the normal plasma volume increase during pregnancy, and "real anaemias" with various different pathophysiological causes. When defining the Hb cutoff value for anaemia in pregnancy, the extent of the plasma volume changes with respect to the gestational age must be taken into consideration. It has been found that haemoglobin values < 11.0 g/dl in the first and third trimesters, and < 10.5 g/dl in the second trimester may point to an anaemic situation which should be further clarified. The first important steps for diagnosing anaemia in a pregnant patient include a thorough check of her medical history and a medical examination. This procedure often lays the basis for a correct diagnosis. The current gold standard to detect iron deficiency remains the serum ferritin value. To be reliable, this requires the ruling out of an infection (chronic or acute) as a cause of the anaemia. We recommend a complete laboratory test for the exact haematological status as well as the assessment of specific chemical laboratory parameters. These should include a palette of additional, promising new parameters such as hypochromic red cells and transferrin receptors which allow more accurate detection of iron deficiency and differential diagnosis of iron deficiency anaemia. After correct diagnosis, major emphasis should be put on safe and effective treatment of anaemia which again depends on severity of anaemia, time for restoration and patients characteristics. Today effective alternatives to oral iron only or blood transfusion such as parenteral iron sucrose complex and in selected cases also recombinant erythropoietin have been investigated and show promising results concerning effective treatment of anaemia during pregnancy and postpartum.
Breymann
C
C
Departement für Frauenheilkunde, Klinik für Geburtshilfe, Universitätsspital Zürich. christian.breymann@fhk.usz.ch
D018798:Anemia, Iron-Deficiency / Q000175:diagnosis* / Q000188:drug therapy; D001803:Blood Transfusion; D003937:Diagnosis, Differential; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage; D010953:Plasma Volume; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000188:drug therapy; D011994:Recombinant Proteins; D012016:Reference Values
D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron
Aktuelle Aspekte der Diagnostik und Therapie der Eisenmangelanämie in der Schwangerschaft.