Postpartum anaemia is defined as a haemoglobin of less than 100 g/l in the postpartum period. Anaemia is common after delivery due to acute blood loss.
Most women lose some blood during delivery. In complicated deliveries, caesarean sections and postpartum haemorrhage, women can lose upwards of 1.5 litres of blood. It is essential to optimise the treatment of anaemia during pregnancy, so that women have optimal haemoglobin and iron stores before delivery.
Management
A full blood count is checked the day after delivery if there has been:
- Postpartum haemorrhage over 500ml
- Caesarean section
- Antenatal anaemia
- Symptoms of anaemia
Treatment of anaemia is based on individual factors and preferences alongside local guidelines. As a rough guide (local policies will vary):
- Hb under 100 g/l – start oral iron (e.g. ferrous sulfate)
- Hb under 90 g/l – consider an iron infusion in addition to oral iron (e.g. Monofer, CosmoFer or Ferinject)
- Hb under 70 g/l – blood transfusion in addition to oral iron
An iron infusion is also considered in women that:
- May have poor adherence or oral treatment
- Cannot tolerate oral iron
- Fail to respond to oral iron
- Cannot absorb oral iron (e.g. inflammatory bowel disease)
Iron infusions carry a risk of allergic and anaphylactic reactions. They should be used with particular caution in patients with a history of allergy or asthma.
TOM TIP: It is worth noting that active infection is a contraindication to an iron infusion. Many pathogens “feed” on iron, meaning that intravenous iron can lead to proliferation of the pathogen and worsening infection. It is important to wait until the infection is treated before giving an iron infusion.
Last updated September 2020