Iron deficiency is the commonest cause for anaemia worldwide making it a formidable issue particularly during pregnancy because of increased iron demands. This study looked at establishing a lower limit of normal for haemoglobin concentration (Hb) in our population and to proactively address potentially symptomatic iron deficiency during the current SARS-CoV-2 pandemic. The lower limit of normal for Hb in our 1715 first trimester pregnancy cohort was 116 g/L. This is in contrast with guidance suggesting Hb levels down to 110 g/L are normal. In addition there was evidence of limited testing performed to look for iron deficiency with only 18% having a serum ferritin checked. Most anaemia was normocytic suggesting that microcytosis is only a late marker of iron deficiency lacking sensitivity. A strategy to avoid hospital contact during the COVID-19 pandemic is proposed.
SynopsisA rare case of a massive hemorrhage from a ruptured splenic artery aneurysm (SAA) in pregnancy that resulted in an emergency laparotomy, splenectomy, and cesarean section with maternal survival, but fetal loss, is presented. The development of protocols or guidelines for the early identification or prevention of SAA rupture in pregnancy would be of greater importance than reactive measures to control acute SAA bleeds.
Main body of text:This study assessed the prevalence of anaemia in a mixed metropolitan and urban setting in in the UK during first trimester of pregnancy to draw conclusions around managing iron deficiency.The provision of healthcare has to adapt to new and innovative ways of delivering evidence-based good care in view of the SARS-CoV-2 pandemic. One area where this could be realised is in the management of iron deficiency particularly in pregnancy. There are excellent UK-based guidelines which need not be replaced but rather adapted in the light of current pandemic 1 .
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