Anemia Management Through Medical Care

Anaemia during pregnancy is one of the most significant public health challenges in India, affecting over half of all pregnant women according to national health surveys. In Andhra Pradesh and Visakhapatnam, the prevalence is substantial, driven by dietary patterns, iron-poor diets, frequent pregnancies, and parasitic infections. Addressing anaemia requires a structured medical approach that goes beyond simple iron tablets.

The consequences of untreated anaemia during pregnancy are serious. For the mother, severe anaemia increases the risk of heart failure, susceptibility to infections, fatigue, and complications during delivery including excessive blood loss. For the baby, maternal anaemia is associated with preterm birth, low birth weight, and reduced iron stores in early infancy.

The World Health Organisation classifies anaemia in pregnancy by haemoglobin levels: mild (10 to 10.9 g/dL), moderate (7 to 9.9 g/dL), and severe (below 7 g/dL). Each level requires a different management approach, and medical care is essential for determining the appropriate intervention based on the severity and underlying cause.

While iron deficiency is the most common cause of anaemia in pregnancy, it is not the only cause. Folate deficiency, vitamin B12 deficiency, thalassemia trait, and chronic diseases can also lead to low haemoglobin levels. A complete blood count, peripheral blood smear, serum ferritin, and reticulocyte count help the doctor identify the specific type of anaemia.

Iron-deficiency anaemia is characterised by low serum ferritin and small, pale red blood cells on the blood smear. Megaloblastic anaemia, caused by folate or B12 deficiency, shows large red blood cells. Thalassemia trait produces small red blood cells with a relatively normal or mildly reduced haemoglobin, and specific haemoglobin electrophoresis testing confirms the diagnosis.

Accurate diagnosis is important because treatment differs for each type. Giving iron supplements for anaemia caused by thalassemia trait, for example, is ineffective and can lead to iron overload. Only through proper medical evaluation can the correct treatment be prescribed.

For mild to moderate iron-deficiency anaemia, oral iron supplements are the first line of treatment. The standard therapeutic dose is typically 100 to 200 milligrams of elemental iron per day, divided into two or three doses. Taking iron with vitamin C-rich foods such as amla, lemon juice, or orange enhances absorption, while tea, coffee, and calcium-rich foods taken simultaneously reduce it.

Common side effects of oral iron include nausea, constipation, dark stools, and metallic taste. These side effects lead many women to stop taking the supplements, which can delay recovery. The doctor can suggest strategies such as taking iron at bedtime, starting with a lower dose and gradually increasing, or switching to a different iron formulation to improve tolerance.

Dietary counselling accompanies medical treatment. Iron-rich foods readily available in Visakhapatnam include green leafy vegetables like spinach and amaranth, jaggery, dates, ragi, eggs, and fish. While diet alone rarely corrects established anaemia, it supports the treatment and helps prevent recurrence after haemoglobin levels normalise.

When oral iron is not tolerated, not absorbed adequately, or when the anaemia is too severe for oral therapy to correct in time before delivery, intravenous iron therapy is recommended. IV iron delivers a large dose directly into the bloodstream, bypassing the gastrointestinal tract, and raises haemoglobin levels more rapidly than oral supplementation.

Modern IV iron preparations such as iron sucrose and ferric carboxymaltose have good safety profiles and are well-tolerated by most patients. The treatment is administered in a hospital or clinic setting under medical supervision, with monitoring for allergic reactions. A single infusion of ferric carboxymaltose can deliver up to 1000 milligrams of iron, significantly reducing the number of visits required.

IV iron is particularly useful in the third trimester when there is limited time before delivery. The response is usually seen within two to three weeks, with a measurable rise in haemoglobin. Follow-up blood tests confirm the effectiveness of the treatment and guide any further management needed.

Blood transfusion is reserved for severe anaemia with haemoglobin below 7 g/dL, particularly when accompanied by symptoms of cardiovascular compromise such as breathlessness at rest, rapid heart rate, or if delivery is imminent. Transfusion provides an immediate increase in oxygen-carrying capacity and can be lifesaving in critical situations.

The decision to transfuse is made carefully by the treating doctor, weighing the benefits against the risks of transfusion reactions, infection, and fluid overload. Packed red blood cell transfusions are preferred over whole blood, and the volume transfused is calculated based on the haemoglobin deficit and the patient's weight.

After treatment, regular haemoglobin monitoring ensures that anaemia does not recur. Iron supplementation is typically continued throughout the remainder of the pregnancy and for at least three months postpartum to replenish iron stores. The doctor determines the maintenance dose based on follow-up blood test results.

Preventive strategies include iron and folic acid supplementation starting early in pregnancy, deworming treatment where indicated, and dietary education about iron-rich foods and factors that enhance or inhibit absorption. Government programmes such as the Pradhan Mantri Surakshit Matritva Abhiyan provide free iron supplements and antenatal care services that support anaemia prevention efforts across India.