Dear Lois So precise and concise A great revision for us all thank you Denise
----- Original Message ----- From: Lois Wattis <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Saturday, November 09, 2002 3:06 AM Subject: Re: [ozmidwifery] Haemoglobin and ferritin levels > Haemoglobin is a pigment contained in the red blood cells which enables them > to transport oxygen round the circulation. It is a compound of the > ferrous-iron containing pigment haem combined with the protein globin. Each > haemoglobin molecule contains 4 atoms of ferrous iron, 1 in each haem group, > and can unite with 4 molecules of oxygen. Anaemia is a reduction in the > number of red blood cells, or in the amount of haemoglobin present in them. > Iron deficiency anaemia is the most common type of anaemia, probably related > to poor nutrition, and is aggravated in early pregnancy due to the > physiological haemodilution which occurs. The haemoglobin level (generally) > used to indicate the presence of anaemia is 11.0 g/dl, considered the lower > limit of the normal range (WHO, 1972) If the Hb level is below 9.0 g/dl > further investigtions such as folate levels and serum ferritin may be > necessary. > > Ferritin is the iron-apoferritin complex; one of the forms in which iron is > stored in the body. Ferritin is the body's major iron-storage protein, > ensuring that iron is readily available when demand is high, and is found in > the liver, marrow and spleen. Serum ferritin falls in proportion to a > decrease in iron store and is a more reliable test of iron status than > haemoglobin level. Normal ferritin levels are 10-200 ug/l. Women who have > low serum ferratin may need supplementation. > > The benefit of iron supplementation is now questioned and some studies show > that the routine administration of iron may be superfluous or even harmful. > Levels of haemoglobin traditionally regarded as pathological in the non > pregant woman are in fact associated with good obstetric outcomes. The > increase in plasma volume is essential to ensure perfusion of the vascular > bed and maintenance of blood pressure and it is suggested that an increase > in Hb may result in a decrease of blood flow through tissues. Routine iron > supplementation in the absence of clinical indications is unnecessary.... > The aim of iron supplementation in normal pregant women is not to elevate > their Hb but to refill their iron stores. A low serum ferritin value is > indicative of depleted iron stores and the need for iron supplementation. > WHO considers anaemia to be present in pregnant women at 11 g/dl or less. > More arbitrary levels may be decided locally and usually range between 10 > and 10.5 g/dl. (Sweet, 1997, p549) > Refer to pages 548-553 of Mayes Midwifery for detailed info. > Sources: Mayes Midwifery 12th Edition (B. Sweet); Baillieres Midwives' > Dictionary 9th Edition. > Addit: Large studies indicate haemoglobin concentrations of 9 to 9.5g/dl are > associated with optimal perinatal outcomes (as they reflect good plasma > volume expansion) Odent, 1998, The Practising Midwife, Vol.1, Number 9. > > > Sue, on the basis of this information, levels of 10 or above for either Hb > or Ferritin do not necessarily warrant supplementation. The clinical > condition of the woman also needs to be taken into account - is she tired, > lethargic, dark circles under the eyes, pale inner eyelids? Breathlessness, > especially on exertion, dizzy or faint? No "silent" bleeding occurring - eg > haemorrhoids? How is her diet? Meat-eater or not? Leafy green veges? > A holistic clinical assessment should accompany diagnostic tests. > > Regarding supplementation suggestions - > Many midwives I encounter recommend Flurodix liquid which is a combination > of iron, B & C vitamins and herbs, minerals etc. which seems to work well > for women low on iron, or manifesting any of the above symptoms. Taking > zinc as well reduces the metallic after taste which some people complain > about from Flurodix. Ferrum phos 6c (cell salts) helps with assimilation of > dietary iron. > > Hope this is helpful. Best wishes, Lois Wattis > > ----- Original Message ----- > From: "Sue Cookson" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Friday, November 08, 2002 7:02 PM > Subject: [ozmidwifery] Haemoglobin and ferritin levels > > > Hi, > Needing some help to clarify the difference between haemoglobin levels and > ferritin levels. > > Have a local GP who switches between the two readings depending on which one > is lowest and suggests/insists on iron injections. > > Levels I've had quoted from some of the women are: > > Hb 107 > Ferritin 14 > > > another: Hb 109 > Ferritin 13 > > These two women are both 32 weeks. > > Just needing clarification and some evidence about the relevance of > both/either readings. Hb levels seem fine to me - a bit foxed by the > ferritin level - one woman had dropped from 120 early pregnancy to 14 now... > > Look forward to your fine input, > > Sue > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
