Treatment of Anemia of Chronic Disease with True Iron Deficiency in Pregnancy

Received May 15, 2017; Revised Jul 18, 2017; Accepted Jul 31, 2017

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1. Introduction

Anemia is one of the most common problems in pregnancy. Anemia diagnosed before mid-pregnancy contributes significantly to maternal and perinatal morbidity and mortality [1–3]. These include premature birth, low birth weight, intrauterine growth restriction, stillbirth, premature rupture of membranes, increased susceptibility to infection, and maternal postpartal complications such as breastfeeding problems, depression, and fatigue [1–5]. Placental development is also affected by anemia and hypoxia, causing abnormal trophoblast invasion and release of hypoxia inducible factor. This consequently increases the incidence of placenta previa and preterm placenta abruption. Mireku et al. report a link between mothers who had anemia lower than 9.0 g/dl during pregnancy with a lower cognitive and motor development in one-year-old children [6].

The etiology of gestational anemia may include the most common causes: deficiencies of iron, folate, vitamin B12, vitamin A, thalassemia, and so on. Iron deficiency anemia is the most common cause of anemia in pregnancy. The criteria of moderate iron deficiency anemia (IDA) are low hemoglobin levels (hemoglobin between 8.0 and 9.9 g/dl) and depleted iron stores (ferritin < 15 μg/l) [1]. A prevalence of iron deficiency anemia in different regions of the world has varied from 12 to 43% [1, 7, 8]. Anemia of chronic disorders (ACD) also termed as anemia of chronic disease or anemia of chronic inflammation is considered to be the second most frequent anemia in the world and is primarily found in subjects suffering from disorders that evolve from the activation of the immune system [9, 10]. The measurements of hypochromic red blood cells (HRC), the reticulocyte hemoglobin content (CHr), and red blood cell distribution width (RDW) provide an accurate description of hemoglobinization of red blood cells and reticulocytes [11–15]. Because of the long circulating lifespan of...