However, once her iron deficiency is corrected, iron supplements should be stopped, and her complete blood count, ferritin and serum iron levels, and total iron-binding capacity should be rechecked in a few months to verify that she is no longer iron deficient and that the anemia was corrected by iron treatment. 5 In this condition, the severity of iron overload and its clinical significance is highly variable, but it is rare for iron overload to develop in women of reproductive age who are generally protected by menstrual blood loss, iron loss associated with pregnancies, and likely by other factors. by far is homozygous or compound heterozygous mutations in the hemochromatosis gene HFE. The most common form of hereditary hemochromatosis in the U.S. Hereditary hemochromatosis is not of immediate concern when the patient is iron deficient. 3 Surprisingly, the effect of mild maternal iron deficiency on the fetus or the developmental benefits of its correction by iron supplementation are still not firmly established. A total dose of 1,000 mg should correct her deficit and leave her with repleted iron stores after a normal delivery. 2 If she is anemic (Hb <10.5 g/dL), then her anemia is very likely caused in part by iron deficiency and IV iron is a reasonable option. If she is not anemic (in this case anemia would be defined as Hb <10.5 g/dL, as Hb norms are adjusted for pregnancy stage), then oral iron such as ferrous sulfate 325 mg, once every other day, should be sufficient to begin to replete her iron stores, although oral iron supplementation is often tolerated poorly by pregnant women. Therefore, this patient (and other women with ferritin levels <30 ng/mL) should be supplemented with iron. However, normal and even high serum ferritin does not rule out iron deficiency because relatively common conditions (e.g., systemic inflammation or acute liver injury) can increase serum ferritin even in the presence of underlying iron deficiency.ĭefining iron deficiency by an exact ferritin cutoff based on reference cohorts of healthy pregnant women (e.g., a serum ferritin level less than 12 ng/mL) would miss many women whose ferritin is slightly above this cutoff but who do not have any iron stores. Low serum ferritin is always diagnostic of depleted iron stores (with the esoteric exception of two reported cases of genetic L-ferritin deficiency). The measurement of serum ferritin detects a form of ferritin secreted into blood plasma mainly by macrophages and hepatocytes, in proportion to body iron stores.
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