Anemia refers to the decrease in the values of hemoglobin (the oxygen carrier protein) below certain normal levels due to the decrease in the size and number of red blood cells, the concentration of hemoglobin in each of them and the value of total hemoglobin. Normal values range between 12-16 gr/dL. in the non-pregnant woman and 11 to 14 gr / dL. in the pregnant In this article we will treat exclusively the anemia of nutritional origin due to low iron intake, Ferropenic Nutritional Anemia.

Considerations

This is one of the most frequent conditions of the world population, in fact, it is a public health problem, it is estimated that at least 2 billion (2,000,000,000,000) of people in the world suffer from this disease at this time and approximately 50% of cases are due to iron deficiency (iron deficiency anemia), therefore it is classified as a nutritional disease and as a disease that fundamentally affects poor populations of the world especially children, adolescents and pregnant women. For example, in one African country (Ivory Coast) anemia was diagnosed in 80% of preschool children (2-5 years) and in 50% of women and children of school age.

How does it manifest? The manifestations of anemia are so varied that it is called the “great simulator” because the symptoms can appear in various ways and forms, suggesting a large number of diseases, depending on each person, their sex, their age and their coexistence with the pregnancy. The signs and symptoms that are most frequently reported due to anemia are the following:

Pale skin and mucous membranes, fragile and brittle nails

Fatigue, weakness, shortness of breath, exercise intolerance, lack of interest

Dizziness, vertigo, headache, tachycardia, palpitations

Inflammation and discomfort of the tongue and throat; lack of appetite

Intense desire to eat non-nutritional substances (pica): eating ice is very common in regions where there is, but the intake of lime from walls (friezes) or soil is frequently reported in many regions, especially poor

What produces it? As previously mentioned, the most frequent cause of anemia (50%) is nutritional deficiency, mainly due to iron deficiency in the diet (iron deficiency, ferropenia) and other factors necessary for the synthesis of hemoglobin (folic acid and vitamin B12) . The remaining 50% of the causes of anemia include a wide variety of acquired or inherited diseases that condition their appearance

How is it diagnosed? The diagnosis is extremely simple and economical. Only a hematology that includes the level of hemoglobin and certain optional values ??associated with red blood cells such as number, shape, color and hemoglobin content is needed. If you do not have a laboratory you can measure the blood hematocrit (column of red blood cells measured in a thin tube) or simply give treatment (without making the laboratory diagnosis) based on the symptoms and signs manifested by the patient

Anemia during pregnancy? This is a special condition because it represents a subgroup frequently affected, with different diagnostic criteria and possible consequences on an innocent witness: the baby

The values ??of hemoglobin concentration during pregnancy are slightly lower than those of the non-pregnant woman and are considered normal between 11 and 14 gr but we speak of anemia during pregnancy when the values ??are less than 11 gr. during the first (weeks 1 to 13) and the last 3 months of pregnancy (weeks 26 to 40) and less than 10.5 gr. during the second trimester (weeks 13 to 26)

The fetus behaves like a very efficient parasite and will always obtain the necessary iron from its mother so that during pregnancy the mother will consume her iron deposits rapidly: making new red blood cells for her own use and the iron transferred to the fetus and your placenta for the synthesis of hemoglobin and other systems that need iron for cellular functioning and development. Therefore, the mother must compensate this new demand by eating iron in her diet or through supplements to cope with this new and inevitable demand.

Diet generally does not compensate for this new demand, so it is necessary to supplement iron intake with the use of iron preparations during most of pregnancy, even in patients without anemia.

Which is the treatment? The correction of blood iron levels and their deposits in the bone marrow is the indicated treatment in iron deficiency anemia, oral and parenteral routes

Prevention: the best strategy is to prevent anemia through an adequate diet, this would not only prevent anemia but all those diseases associated with malnutrition. This seems easy but it must be remembered that the majority of the world population lives in borderline or frankly precarious nutritional conditions. Governments are responsible for the nutrition of their people.

The use of iron supplements before, during and after pregnancy prevents anemia and its complications

Slow treatment: Once the presence of anemia is diagnosed, we usually use ferrous preparations administered orally in doses a little higher than the routine preventive dose. Most patients are managed in this way if the diagnosis is made early, the hemoglobin values ??are higher than 8.5 gr, the patient is asymptomatic or the date of delivery is not very close

Rapid treatment: in cases of severe anemia with values less than 8.5 gr. and in the presence of symptomatic patients or with very close delivery dates we choose fast treatments that may include intramuscular or intramuscular iron use

Immediate treatment: we resort to blood transfusions in the patient with severe anemia (almost always in symptomatic patients with values less than 6 gr.) Especially if we are at the date of delivery or cesarean section. Subsequently, the patient must consume iron supplements to correct their circulating iron deficit and fill their deposits to avoid the recurrence of anemia.

What I can do?

A balanced diet with animal products is the most important action to avoid a severe anemic picture, the diet should include beef, chicken or fish. Human beings are omnivores.

Taking your iron supplements prevents the occurrence of anemia before and during pregnancy because iron requirements will increase.

If you are totally vegetarian you should use iron supplements and vitamin B12 to allow all your needs and those of the baby to be met. The vegetarian diet does not provide the daily requirements of vitamin B12.

Bariatric patients: supplement vitamin B12 by intramuscular injection with the regularity that the plasma levels of the vitamin indicate to maintain normal values, otherwise anemia will not be prevented or corrected

How long should the iron be taken? Throughout the pregnancy, particularly after the 18th week of pregnancy and the time that is necessary after delivery to fill your iron deposits in bone marrow. If you present anemia, the form of supplementation or correction indicated for your particular case will begin.