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As per WHO, anemia is defined as hemoglobin less than 11 g%.

Causes of anemia in pregnancy:

  1. Physiological (hemodilution)
  2. Pathological:
    1. Iron deficiency anemia (IDA) (hypochromic and microcytic)
    2. Megaloblastic anemia (macrocytes, hypersegmented neutrophils, and Howell-Jolly bodies)
    3. Dimorphic/nutritional anemia
    4. Hemorrhagic anemia
    5. Hemolytic anemia
    6. Hemoglobinopathies

Criteria of physiological anemia:

  1. Hb: 10 g%
  2. RBC: 3.2 million/mm'
  3. PCV:30%
  4. Peripheral smear: normocytic and normochromic
  5. Mean Corpuscular Hemoglobin Concentration remains unchanged in pregnancy.

Effects of Anemia




Easy fatigability


Palpitations/ tachycardia/ cardiac failure


Increased susceptibility to infection

Increased perinatal mortality

Pre-term labor


Maternal death



  1. MC cause of anemia in pregnancy is dimorphic anemia (iron, folic acid, and vitamin B12 deficiency).
  2. Anemia is the most common indirect cause of maternal mortality.
  3. Asper CDC, Sr. ferritin less than 15 μg/L confirms iron deficiency anemia.
  4. Indications for parenteral iron:
    1. Noncompliant patient
    2. Nontolerance to oral iron
    3. Malabsorption syndrome
  1. Parenteral iron is not given for rapid rise of Hb as the rise in Hb is the same with oral, i.m., and i.v iron.
  2. It is about 0.7-1 g/dL per week.
  3. Fastest rise of Hb is with blood transfusion.

For i.v. iron test dose is to be given by i.v. route and for i.m. iron test dose is to be given i.m.


Different formulae for calculations of dose of parenteral iron:

  1. Formula 1 (Normal Hb in g - patient's Hb in g) x Weight (in kg) x 2.21 + 1000 (for stores) = mg of iron needed
  2. Formula 2 250 mg of iron is required for each gram of Hb below normal
  3. Formula 30.3 x weight (in pounds) x (100 – Hb %) = mg of iron needed. Add 50% of this for stores Government of

India distributes tablets at Primary health care centers. The iron content of each tablet is 100 mg and the folic acid content is 500μg.

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