scholarly journals KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN (Diagnostic Validity of Reticulocyte Hemoglobin for Iron Deficiency Detection in Pregnancy)

Author(s):  
Tri Ratnaningsih ◽  
Budi Mulyono ◽  
Sutaryo Sutaryo ◽  
Iwan Dwiprahasto

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume andthe development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stageparameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-Heexamination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those interm pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered fromPKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from thecubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while theRet-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serumof the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzerC501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two(2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were alsoclassified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%). From 291subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency inpregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for irondeficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively.The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.

Author(s):  
Tri Ratnaningsih ◽  
Budi Mulyono ◽  
Sutaryo Sutaryo ◽  
Iwan Dwiprahasto

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume and the development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stage parameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-He examination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those interm pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered from PKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from the cubital vein of the subjects. Two mL of the sample was tested for routine  hematological examination using an EDTA tube, while the Ret-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serum of the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzer C501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two (2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were alsoclassified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%). From 291 subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency in pregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for iron deficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87%  respectively. The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.


2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Selfesina Sikoway ◽  
Yanti Mewo ◽  
Youla Assa

Abstract: Hemoglobin (Hb) is a parameter used to determine anemia prevalence. The average level of normal Hb at the end of pregnancy is around 12.5 g/dL, meanwhile, aproximately 5% of pregnant women have Hb level less than 11.0 g/dL. To date, Hb level below 11.0 g/dL especially at the end of pregnancy should be considered as an abnormal phenomenon and is usually caused by iron deficiency and not by hypervolemia which is commonly found in pregnancy. This study was aimed to determine the hemoglobin level of third semester pregnant women in Robert Wolter Mongisidi Hospital Manado. This was a descriptive study with a cross sectional design. Subjects were 39 third semester pregnant women who visited the Obstetric Department of Robert Wolter Mongisidi Hospital and fulfilled the inclusion criteria. The results showed that 25 subjects (64.1%) had low hemoglobin levels and 14 subjects (35.9%) had normal level of hemoglobin. In conclusion, most third semester pregnant women had low hemoglobin levels.Keywords: hemoglobin rate, third trimester pregnant women, anemia Abstrak: Hemoglobin (Hb) darah merupakan parameter yang digunakan untuk menetapkan prevalensi anemia. Nilai normal Hb pada akhir kehamilan rata-rata 12,5 g/dL, dan sekitar 5% wanita hamil konsentrasinya kurang dari 11,0 g/dL. Nilai Hb dibawah 11,0 g/dL terutama pada akhir kehamilan perlu dianggap abnormal dan biasanya disebabkan oleh defisiensi besi dan bukan karena hipervolemia yang umumnya ditemukan pada kehamilan. Penelitian ini bertujuan untuk mengetahui kadar hemoglobin pada ibu hamil trimester III di Rumah Sakit Robert Wolter Mongisidi Manado. Jenis penelitian ialah deskriptif dengan menggunakan desain potong lintang. Subyek penelitian ialah 39 ibu hamil trimester III yang berkunjung di Poliklinik Kebidanan di Rumah Sakit Robert Wolter Mongisidi Manado yang memenuhi kriteria inklusi. Hasil penelitian menunjukkan 25 subyek (64,1%) memiliki kadar hemoglobin rendah dan 14 subyek (35,9%) memiliki kadar hemoglobin normal. Simpulan penelitian ini ialah sebagian besar ibu hamil trimester III memiliki kadar hemoglobin rendah.Kata kunci: kadar hemoglobin, ibu hamil trimester III, anemia


2019 ◽  
Author(s):  
Samson Udho ◽  
Joyce Nankumbi ◽  
Mariam Namutebi ◽  
Grace Ndeezi ◽  
Joshua Epuitai ◽  
...  

Abstract Background Iron deficiency is a leading cause of anemia among pregnant women in Uganda. However, due to the high cost of biochemical tests required to determine iron deficiency, the prevalence and factors associated with iron deficiency remain largely unstudied in our setting. Therefore, this study aimed at determining the prevalence of iron deficiency and its associated factors among pregnant women attending an antenatal clinic, Lira District-Uganda.Methods A cross-sectional study was conducted among 320 pregnant women attending an antenatal clinic at Lira Regional Referral Hospital. Maternal serum ferritin was used as a measure of iron deficiency and was determined using a Cobas 6000 Automated Analyzer. Iron deficiency was based on serum ferritin of <30 μg/L. A semi-structured questionnaire was used to obtain the characteristics of the study participants. Binary and multivariate logistic regression were performed to identify the associated factors.Results The prevalence of iron deficiency was 45%. Non-adherence to iron supplements (AOR: 2.05 95% CI: 1.02-4.12) & third trimester pregnancy (AOR: 1.88 95% CI: 1.20-2.94) were significantly associated with iron deficiency during pregnancy.Conclusion Nearly 5 in 10 of the participants had iron deficiency. Iron deficiency during pregnancy was associated with non-adherence to iron supplements and being in the third trimester of pregnancy. Midwives should encourage pregnant women to adhere to iron supplements during pregnancy especially pregnant women who are in the third trimester.


2019 ◽  
Vol 15 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Saroj Thapa ◽  
Madhab Lamsal ◽  
Sanjay Kumar Sah ◽  
Rajendra Kumar Chaudhari ◽  
Basanta Gelal ◽  
...  

Background: Iron deficiency is the most common nutritional deficiency in the world. The relation between thyroid hormones and iron status is bidirectional. The aim of this study was to assess iron nutrition status and evaluate its relationship with thyroid hormone profile among children of Eastern Nepal. Methods: A  community based cross-sectional study was conducted in eastern Nepal. A total of 200 school children aged 6-12 years were recruited after taking informed consent from their guardians. Blood samples were collected and assayed for free thyroid hormones (fT3 and fT4), thyroid stimulating hormone (TSH), serum iron, total iron binding capacity (TIBC) concentration and percentage transferrin saturation was calculated. Results: The mean serum iron and TIBC was 74.04 µg/dl and 389.38 µg/dl respectively. The median transferring saturation was 19.21%. The overall prevalence of iron deficiency (Transferrin saturation < 16%) was 34% (n=68). The mean concentration of fT3 and fT4 was 2.87 pg/ml and 1.21 ng/dl respectively, while the median TSH concentration was 3.03 mIU/L. Median TSH concentration in iron deficient group (3.11 µg/dl) and iron sufficient group (2.91 µg/dl) was not significantly different. Among iron deficient children 5.9% had   subclinical hypothyroidism (n=4). Iron status indicators were not significantly correlated with thyroid profile parameters in the study population. Conclusions: The prevalence of iron deficiency is high and iron   deficiency does not significantly alter the thyroid hormone profile in the study region.


Author(s):  
Mohammad Zulkarnain ◽  
Rizka Muliani ◽  
Rico Januar Sitorus ◽  
Nurlaili Nurlaili

Pregnant women are at risk for iron deficiency anemia especially pregnant women in malaria-endemic areas. This study aimed to analyze the profile of iron in the third trimester pregnant women with iron deficiency anemia in co-endemic area of Bengkulu city. This study was cross-sectional study with a total sample of 66 pregnant women who met the inclusion criteria. Examination profile of iron in pregnant women is done by taking blood specimen through the vena cubity. Profile iron includes examination sTfR levels, hepcidin, transferrin were examined by ELISA. Determination of iron deficiency anemia is based on the results of Hb, serum iron and TIBC. The results showed 39.4% of pregnant women experience iron deficiency anemia. There is an average difference between hepcidin levels with the incidence of iron deficiency anemia (p-value 0.031). Based on binary logistic regression analysis profile iron with irondeficiency anemia in pregnant women, hepcidin levels are predictors factors on the incidence of iron deficiency anemia (p-value 0.000, 95% CI .296-.709).


2020 ◽  
Author(s):  
Avinash Pandey ◽  
Shivkant Singh ◽  
Raj Aryan ◽  
Krishna Murari

Background: In treatment naive Indian cancer patients, prevalence of iron, B12 deficiency and inflammatory anaemia in poorly known. Aims and Objectives : To evaluate prevalence of anaemia and iron, B12 deficiency along with inflammation in treatment naive individual consecutive cancer patients. Material and Methods: All patients registered from 1st July 2019 till 31st December 2019 in Medical Oncology Outpatient Department were offered to undergo Iron profile, Serum B12 levels and Serum ferritin along with routine haematological investigations. Anaemia was defined as Haemoglobin < 11gm/dL. Transferrin saturation <20%, Serum Ferritin >300 microgram/litre and Vitamin B12 level <200 picogram/millilitre were 'cut-offs' used to define iron deficiency, inflammation and Vitamin B12 deficiency respectively. Data was analysed using descriptive statistics, frequency distribution, crosstabs and Bar Diagram in SPSS version 17.0. Pearsons Chi square test and Odds ratio was used to measure the strength of association with variables. Results: 311/441 (70.5%) were found eligible. Median age was 52 + 15.9 (Range 18-84 ) years with 144/331(46%) females. The prevalence of anaemia was 61% + 2.7 (95% CI 55-66%). Mean Haemoglobin was 9.86 + 2.08 (range 3-16) gram/decilitre. 21/311(7%) had severe anaemia (Haemoglobin < 6.9 gm/dl). 135/311 (71%), 61/189 (32%) and 89/189 (47%) anaemic patients had iron deficiency, inflammation and B12 deficiency respectively. More than 70% of Gastrointestinal (50/69), Gynaecological(17/24) and Lung Cancer(18/22) patients had underling Iron deficiency. Conclusion: Two-third of cancer patients are iron deficient. B12 deficiency and inflammation are present in half and one-third patients respectively.


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4896-4896
Author(s):  
Grace Tang ◽  
Andrea Lausman ◽  
Jessica Petrucci ◽  
Jameel Abdulrehman ◽  
Rosane Nisenbaum ◽  
...  

Abstract Background Iron deficiency (ID) is the most common and widespread nutritional deficiency in both developing and developed countries (WHO, 2001; Mei et al., 2011). Women of child bearing age are at the highest risk, but this risk increases even more during pregnancy. The expansion of blood volume, growth of the fetus and placenta increase demand for iron to approximately 5.0mg/day by the third trimester (Met et al., 2011). Common symptoms of ID during pregnancy include fatigue, shortness of breath, and difficulty concentrating (WHO, 2001). Poor prenatal iron status is associated with diminished cognitive performance, language ability, and motor functions in the child (Tamura et al, 2002). For the mother, it is associated with risk of blood transfusion and post-partum depression. Despite international recommendations and guidelines on the management of ID in pregnancy, it remains a problem of epidemic proportions and is often unrecognized and left untreated. To increase awareness of ID, a quality improvement project, IRON Deficiency project in Pregnancy: Maternal Iron Optimization (IRON MOM) was implemented January 1st, 2017 at St. Michael's Hospital (SMH), in Toronto, Canada. Phase 1 of the project involved adapting lab requisitions and workflow in the obstetrics clinic to incorporate routine measurement of ferritin in week 12, 16 and 28 of pregnancy. As part of the IRON MOM, laboratory requisitions were modified to include ferritin as part of routine screening for all pregnant women. Objective The primary objective of this study was to assess the prevalence of ID in pregnant women consistently screened for ID after the implementation of the IRON MOM quality improvement project at a tertiary hospital in Toronto, Canada. Methods Administrative laboratory data was collected from the electronic medical record system at SMH, Toronto, Canada between January 1 and December 31, 2017. Suboptimal iron stores was defined as serum ferritin between 30-50μg/L. ID was defined as serum ferritin between 15-29μg/L, and severe ID was defined as <15μg/L. Significant anemia was defined as hemoglobin levels <100 g/L. Descriptive statistics were used to calculate proportions. SAS version 9.4 was used to perform the analyses. Results In 2017, 2400 ferritin tests were completed on pregnant women at our institution. A total of 76.8% (1844/2400) of tests demonstrated iron deficiency with a ferritin <30μg/L. Of those, 30.2% (726/2400) had ferritin between 15-29μg/L, and 46.6% (1118/2400) were severely iron deficient with a ferritin <15μg/L (Figure 1). 3282 hemoglobin checks, at delivery, occurred in this same one-year period and 10.5% (345/3282) were significantly anemic (<100 g/L). Of those, 6.2% (204/3282) had hemoglobin levels between 90-99g/L, 2.6% (85/3282) had hemoglobin levels between 80-89g/L, and 1.7% (56/3282) had hemoglobin levels <80g/L. Conclusion We found an extremely high prevalence of ID in our pregnant patient population. This confirms that ID remains an underappreciated problem, even at a tertiary care centre. Our findings highlight a tremendous gap in awareness, which demands strategies to improve knowledge translation. Future directions include the simplification and digitization of IRON MOM to empower pregnant patients to advocate for their care. Figure 1. Figure 1. Disclosures Lausman: Ferring: Other: gave a talk.


Med Phoenix ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 54-63
Author(s):  
Ravi Kumar Shah ◽  
Jagat Prasad Deep ◽  
Zarin Rahman ◽  
Pravin Shah ◽  
Neha Nayak ◽  
...  

Background: Anaemia in pregnancy is a global health challenge. It is the commonest medical disorder of pregnancy and a major cause of morbidity and mortality in developing countries. Main cause of anaemia in obstetrics is iron deficiency. There are specific risks for the mother and the fetus such as intrauterine growth retardation, prematurity, and blood transfusion. Hence, the importance of giving iron in the antenatal period and to be continued postnatally. Objectives: The study was conducted to determine the overall prevalence of anaemia among pregnant women presenting in third trimester and its effect on pregnancy outcome. Methods: This is a cross sectional descriptive study done at National Medical College & Teaching Hospital from September 2015 to August 2016. During the study period 2048 pregnant women attended antenatal clinic in third trimester. Among 2048, 1200 were booked cases and out of these women with haemoglobin less than 11gm/dl were labeled as anaemia. The prevalence was calculated along with the maternal and fetal outcome. Result: Among 2048, 1200 were booked cases, 368 (30.66%) were anemic, 66.30% were multigravida, 67.93% in age group of 21-30 years, 284 patients came for delivery. In 14.08% patients there was preterm labour, apgar score less than 7 in 66.19% babies. Majority of neonate weighed between 2.0 - 2.5kg (49.29%). Perinatal deaths were 2.81%. Conclusion: Anaemia in pregnancy need awareness about early and regular antenatal care with oral iron supplementation. Correction of anaemia will reduce the maternal and fetal complications.  


2021 ◽  
Vol 9 ◽  
Author(s):  
Evelyine B. Ngimbudzi ◽  
Siriel N. Massawe ◽  
Bruno F. Sunguya

Introduction: The burden of anemia in pregnancy is of global health importance. Tanzania is no exception. Its effects vary from one region to another due to the differing causes. Overall, it is a significant cause of maternal mortality. This study sought to assess the prevalence and factors associated with anemia among pregnant women attending the antenatal clinic (ANC) in the Mkuranga district of the Pwani region of Tanzania.Methodology: This cross sectional study was conducted among 418 pregnant women aged 15–49 years attending the Mkuranga District Hospital and Kilimahewa Health Center. The outcome variable of interest was anemia in pregnancy defined as a hemoglobin concentration of 11 g/dl or less. Data was collected using face-to-face interviews with a standardized pretested questionnaire, and through blood samples collected for hemoglobin testing. Descriptive analysis was used to determine the prevalence of anemia while multiple logistic regression was used to determine factors associated with anemia in pregnancy.Results: Anemia was prevalent among 83.5% of pregnant women attending the two major ANCs in Mkuranga district. Categorically, the hemoglobin of 16.3% of the included women was normal, 51.9% had moderate anemia, 24.4% had mild anemia, and 7.2% had severe anemia. Factors associated with anemia included being in the third trimester (AOR = 2.87, p = 0.026), not consuming vegetables (AOR = 2.62, p = 0.008), meat (AOR = 2.71, p = 0.003), eggs (AOR = 2.98, p = 0.002), and fish (AOR = 2.38, p = 0.005). The finding of unadjusted analysis revealed that women with inadequate minimum dietary diversity were having significantly greater odds of being anemic as compared with those with adequate dietary diversity (OR = 1.94, P = 0.016).Conclusion: More than 80% of pregnant women attending ANC in Mkuranga districts were anemic. Such unprecedented burden of anemia is associated with several factors, which include poor dietary practices such as not consuming iron-rich foods, for example vegetables, meat, eggs, and fish. Women in their third trimester were also more likely to suffer from anemia. This unprecedented burden of anemia in pregnancy can be addressed if efforts to improve feeding practices and early monitoring at the ANCs are sustained.


Author(s):  
Olivia Nakiyemba ◽  
Susan Obore ◽  
Milton Musaba ◽  
Julius Wandabwa ◽  
Paul Kiondo

Pica is the craving and purposive eating of nonfood items. It is common worldwide and presents among vulnerable populations like children and pregnant women. Its etiology and health consequences are not well understood. The aim of this study was to determine the prevalence and covariates of pica among pregnant women attending antenatal clinic at Kawempe hospital in Uganda. We conducted a cross-sectional study from July 2019 to December 2019. Participants in this study were 307 pregnant women who had come to attend antenatal clinic at the hospital. The prevalence of pica was computed. Bivariate and multivariable analysis was done to establish the factors that were independently associated with pica. The prevalence of pica was 57%. The most common type of pica was geophagia (eating clay and sand) followed by pagophagia (eating ice). Of the women who practiced pica, half consumed the nonfood items daily. Factors independently associated with pica were being in the third trimester (adjusted OR [aOR]: 3.60; 95% CI: 1.36–9.48] and having nausea in pregnancy (aOR: 2.11; 95% CI: 1.20–3.70). At Kawempe hospital, pica is common among women who attend the antenatal clinic and is associated with having nausea in pregnancy and being in the third trimester. Health workers need to counsel pregnant women about the dangers of pica so as to reduce helminth infections and micronutrient deficiency associated with it.


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