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Anaemia investigations & Haemoglobinopathy Screening in Preg

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by

Giselle Gerber

on 18 November 2013

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Transcript of Anaemia investigations & Haemoglobinopathy Screening in Preg

Anaemia Investigations & Haemoglobinopathy Screening in Pregnancy
Iron Deficiency
Think ahead!
>>> Check the ferritin!
Why all the fuss?
Iron deficiency
1. Common and undertreated
2. Opportunity to reduce anaemia

Haemoglobinopathies
1. Unfamiliarity
2. Acceptable risk has changed
3. Limited timing for intervention
4. Clinically significant during pregnancy
5. Confusion
- Causes of low MCV
- Normal MCV in Haemoglobinopathy.
Haemoglobinopathies
Universal vs selective screening
Who?
What?
When?
Partner? Yes!
Please identify these patients -
request
iron studies & HbEPG.

Please DOCUMENT clearly on the request form:
gestation
,
ethnicity
,
partner's name
&
DOB
.

Review results and arrange follow-up

Ask us to help you!
Algorithm for familiarization
Lost iron at delivery
500ml blood loss ~ 250mg elemental iron
Body stores: 500-1500mg elemental iron
1ug ferritin ~ 8-10mg storage iron

Ferritin of 30ug = 250mg storage iron
= 500ml blood loss
Replace iron promptly & thoroughly
Who?
High risk patients
Ethinicity:
SE Asian, Asian, Indian, Mediterranean, Arabic, Black African

MCV < 86fl
'Silent' Carriers
Dilemma in screening!
eg. 1 gene alpha thal trait,...
What?
FBC + film
HbEPG (HPLC will be included)
Iron studies
When?
As early as possible!!

The process takes time...
HbEPG 3-4 days > clinical contact > clinical review, genetic counselling > DNA studies: 6-8 weeks... all prior to amniocentesis?!?
Partner?
YES!

Clinical significance in autosomal recessive conditions relies on both parents' genotype

Document clearly, so SEALS can give you a combined report
So...
Full transcript