New guidelines for the diagnosis and investigation of anaemia in pregnancy

New threshold values for anaemia in second and third trimesters of pregnancy

The most recent circular issued by the Family Health Bureau, Sri Lanka has changed the previous guideline on thresholds for anaemia in pregnancy. The previous guideline recommended a haemoglobin value of 11 g/dl in all three trimesters. The Rajarata Pregnancy Cohort (RaPCo) data clearly showed that this will overestimate the anaemia in the second trimester by almost 80%. The paper calling for global consensus for anaemia threshold were published by the DoCM researchers in 2021 in BMJ Global Health. Based on these data, a national consultative meeting was held and all stakeholders agreed that the threshold for anaemia in the second and third trimesters should be 10.5 g/dl. The new circular issued by the FHB has changed the outdated guidelines.

Screening for thalassemia

The same circular provides the necessary instructions for screening for thalassemia, a condition which seems to be responsible for about one fourth to one fifth of anemia in pregnancy in Sri Lanka. These findings were also a major outcome of the RaPCo.

According to the new circular, all anaemic pregnant women with MCV<80 fl and MCH <27pg should be referred to exclude Thalassemia

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Department of Community Medicine
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