Can anemia in pregnant women be treated directly through blood transfusions?

Pregnant women are prone to iron deficiency

Anemia in pregnant women tends to be caused by problems with iron deficiency from food intake. This anemia is known as iron deficiency anemia.

In fact, the need for iron will increase gradually during pregnancy. Initially you will only need an additional 0.8 mg of iron per day in the first trimester, up to 7.5 mg per day in the third trimester.

However, iron from food alone will not be able to meet your needs during pregnancy. That's why pregnant women need additional iron supplements.

Throughout the pregnancy period, the mother needs additional iron intake to ensure the fetal growth and development process is going well, as well as maintaining optimal placental condition. Adequate intake of iron from food and blood-boosting drugs at the same time to avoid the risk of losing a lot of blood during labor later.

Signs and symptoms of anemia in pregnant women

Unlike ordinary anemia, anemia in pregnant women tends to be influenced by changes in body hormones that affect the process of producing blood cells.

Pregnant women generally experience an increase in blood plasma volume by about 50% by the end of the second trimester, while red blood cells only increase by about 25-30 percent. This will cause a decrease in hemoglobin (Hb) levels. Anemia itself occurs when the amount of hemoglobin in the blood is drastically reduced.

Another change related to blood production that is also found in nearly 10% of healthy pregnant women is a drop in platelet (platelet) levels that are below normal - to around 150,000-400,000 / uL. This condition is called thrombocytopenia.

This is important to know to prevent the risk of getting unnecessary blood transfusions due to misrepresenting blood test results during pregnancy.

Pregnant women need to check their Hb levels regularly

According to the Centers for Disease Control and Prevention (CDC) in the United States, anemia in pregnant women is defined according to their gestational age, namely Hb levels of 11 g / dL or Hct <33% in the first and third trimesters, and Hb levels <10.5 g / dL or Hct <32% in the second trimester.

Meanwhile, according to the World Health Organization (WHO), in general, a pregnant woman is said to have anemia if the hemoglobin (Hb) level is less than 11 g / dL or the hematocrit (Hct) is less than 33 percent.

Given the risk of complications of anemia in mothers and babies, that's why the Ministry of Health of the Republic of Indonesia recommends every pregnant woman to take routine blood tests (including to check Hb levels). Ideally, once during the first antenatal examination and again in the third trimester.

So, when do pregnant women need blood transfusions?

Anemia is said to be in a severe stage and needs to be taken to the ER when the Hb level is less than 7 g / dL. However, the decision to get a transfusion for pregnant women still requires careful consideration by taking into account the needs, as well as the risks and benefits.

If your obstetrician considers anemia to put your pregnancy at high risk for hemoglobinopathy or to lose a lot of blood during delivery (either by vaginal or cesarean section), your doctor may decide to immediately find a blood donor that is suitable for you.

Pregnant women with an Hb level of around 6-10 g / dL are also recommended to get blood transfusions immediately if they have a history of postpartum bleeding or previous haematological disorders.

Transfusions are needed if anemia causes a pregnant woman's Hb level to drop drastically below 6 g / dL and you will give birth in less than 4 weeks.

Common transfusion targets for pregnant women are:

Hb> 8 g / dL
Platelets> 75,000 / uL
Prothrombin time (PT) <1.5x control
Activated Prothrombin Time (APTT) <1.5x control
Fibrinogen> 1.0 g / l

But it must be remembered, the doctor's decision to perform a blood transfusion is not solely by looking at your Hb level alone. If the doctor thinks that your pregnancy is stable, aka not at risk, even though your Hb level is less than 7 g / dL, you don't need a blood transfusion.

In addition, blood transfusions cannot be seen as a solution to eliminate the underlying cause of anemia in pregnant women or to improve other side effects caused by iron deficiency.

Tips to prevent anemia in pregnant women

The CDC recommends that all pregnant women take iron supplements as much as 30 mg per day from the time they check their womb for the first time.

Meanwhile, WHO and the Indonesian Ministry of Health recommend a 60 mg iron supplement for all pregnant women as soon as the symptoms of nausea and vomiting (morning sickness) have subsided.

Don't forget to intake folate since before pregnancy, huh!

Although most cases of anemia in pregnant women are caused by iron deficiency, some pregnant women are also prone to anemia due to folic acid deficiency.

Folic acid is a very important source of nutrients for pregnant women. Currently, folic acid supplementation is mandatory for all pregnant women because of its function in helping the process of fetal DNA synthesis while in the womb and for regenerating the mother's body tissues.

WHO and the Indonesian Ministry of Health recommend folic acid supplementation of 400 mcg / day. Start as soon as possible before planning pregnancy, and continue until 3 months after delivery.