SummaryIron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally. Although it is particularly prevalent in less-developed countries, it remains a significant problem in the developed world, even where other forms of malnutrition have already been almost eliminated. Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion. The objective of this guideline is to provide healthcare professionals with clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period. This is the first such guideline in the UK and may be applicable to other developed countries. Public health measures, such as helminth control and iron fortification of foods, which can be important to developing countries, are not considered here. The guidance may not be appropriate to all patients and individual patient circumstances may dictate an alternative approach. Keywords: iron, iron depletion, iron deficiency, anaemia, pregnancy.The guideline group was selected by the British Society for Haematology, Obstetric Haematology Group (BSH OHG) and British Committee for Standards in Haematology (BCSH), to be representative of UK-based medical experts. MEDLINE and EMBASE were searched systematically for publications from 1966 until 2010 using the terms iron, anaemia, transfusion and pregnancy. Opinions were also sought from experienced obstetricians and practice development midwives. The writing group produced the draft guideline, which was subsequently considered by the members of the BSH Obstetric Haematology Group and revised by consensus by members of the General Haematology Task Force of the BCSH. The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the BSH Committee and comments incorporated where appropriate. Criteria used to quote levels of recommendation and grades of evidence are as outlined in the Procedure for Guidelines Commissioned by the BCSH. Summary of key recommendations• Anaemia is defined by Hb <110 g/l in the first trimester, <105 g/l in the second and third trimesters and <100 g/l in the postpartum period.• Full blood count (FBC) should be assessed at booking and at 28 weeks.• All women should be given dietary information to maximize iron intake and absorption.• Routine iron supplementation for all women in pregnancy is not recommended in the UK.• Unselected screening with routine use of serum ferritin is generally not recommended although individual centres with a particularly high prevalence of 'at risk' women may find this useful.• For anaemic women, a trial of oral iron should be considered as the first line diagnostic test, whereby an increment demonstrated at 2 weeks is a positive result.• Women with known haemoglobinopathy should have serum ferritin checked and offered oral supplements if their ferritin level is <30 lg/l. • Women with unknown haemoglobinopathy status with a normocyti...

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SummaryThrombocytopenia is a common finding in pregnancy, occurring in approximately 7-10% of pregnancies. It may be a diagnostic and management problem, and has many causes, some of which are specific to pregnancy. Although most cases of thrombocytopenia in pregnancy are mild, and have no adverse outcome for either mother or baby, occasionally a low platelet count may be part of a more complex disorder with significant morbidity and may be life-threatening. Overall, about 75% of cases are due to gestational thrombocytopenia, 15-20% secondary to hypertensive disorders; 3-4% due to an immune process, and the remaining 1-2% made up of rare constitutional thrombocytopenias, infections and malignancies. In this review, a diagnostic approach to investigating thrombocytopenia in pregnancy is presented, together with antenatal, anaesthetic and peri-natal management issues for mother and baby, followed by a detailed discussion on the specific causes of thrombocytopenia and the management options in each case.