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Iron Deficiency Anemia and Peripartum Transfusion in a High-Risk Urban Patient Population
Abstract Number: SA-02
Abstract Type: Original Research
INTRODUCTION: Anemia in pregnancy, which is defined by the World Health Organization as hemoglobin (hgb) of < 11 g/dL, is common.1 Iron deficiency anemia (IDA) is associated with multiple adverse consequences for the patient and her infant, including low fetal birthweight, compromised maternal-neonatal bonding, and an increased incidence of maternal postnatal depression.2 We performed a retrospective observational study to identify the rates of third trimester and peripartum anemia among transfused obstetric patients registered versus unregistered within the University of Chicago hospital system prior to their admission delivery.
METHODS: Following IRB approval we identified transfused patients who delivered at ≥23 weeks gestation between January 2011 and March 2015 from an institutional database. Data extraction included hgb levels during 3rd trimester and on delivery admission and discharge, mode of delivery, estimated blood loss, units transfused, 6 wk postpartum hgb levels, oral or IV iron supplementation, self-reported adherence to iron therapy, and postpartum Edinburgh depression scores. Whether patients were registered or unregistered to our institution at time of delivery was documented.
RESULTS: Among the 6265 women included in our database144 (2.3%) were transfused (registered 93 (2.0%) and unregistered 51 (2.4%) (P=0.23)). Rate of anemia in the third trimester was 66% among patients who received prenatal care at our institution, and 62% on delivery admission for all patients. Registered patients had lower rates of anemia on admission than unregistered patients (62% vs 78% P=0.048). Among transfused patients adherence to iron therapy was reported by only 35%. In transfused patients, 31% had an abnormal Edinburgh, indicating depression, although Edinburgh’s were not recorded for 92 patients.
CONCLUSIONS: The prevalence of anemia was high in our cohort of transfused women compared to the prevalence of IDA of 17% in industrialized countries,3 and anemia was apparent in the third trimester in a large proportion. With low adherence to oral iron, there may be a role for more aggressive intravenous therapy to treat antepartum anemia, decrease transfusion requirements, and to improve Edinburgh scores.
1. WHO. Iron deficiency anemia. 2001;WHO/NHD/01.3
2. Milman: Am Hematol 2011;90:1247-3
3. Khalafallah: Journal of Pregnancy 2012;2012:1-10