Department of Clinical Biochemistry and Obstetrics, Næstved Hospital, Næstved, Denmark.
Ann Hematol. 2012 Feb;91(2):143-54. doi: 10.1007/s00277-011-1381-2. Epub 2011 Dec 9.
This review focuses on the prevention and treatment of anemia in women who have just given childbirth (postpartum anemia). The problem of anemia both prepartum and postpartum is far more prevalent in developing countries than in the Western societies. The conditions for mother and child in the postpartum, nursing, and lactation period should be as favorable as possible. Many young mothers have a troublesome life due to iron deficiency and iron deficiency anemia (IDA) causing a plethora of symptoms including fatigue, physical disability, cognitive problems, and psychiatric disorders. Routine screening for postpartum anemia should be considered as part of the national maternal health programs. Major causes of postpartum anemia are prepartum iron deficiency and IDA in combination with excessive blood losses at delivery. Postpartum anemia should be defined as a hemoglobin level of <110 g/l at 1 week postpartum and <120 g/l at 8 weeks postpartum. Bleeding exceeding normal blood losses of approximately 300 ml may lead to rapid depletion of body iron reserves and may, unless treated, elicit long-standing iron deficiency and IDA in the postpartum period. The prophylaxis of postpartum anemia should begin already in early pregnancy in order to ensure a good iron status prior to delivery. The most reliable way to obtain this goal is to give prophylactic oral ferrous iron supplements 30-50 mg daily from early pregnancy and take obstetric precautions in pregnancies at risk for complications. In the treatment of slight-to-moderate postpartum IDA, the first choice should be oral ferrous iron 100 to 200 mg daily; it is essential to analyze hemoglobin after approximately 2 weeks in order to check whether treatment works. In severe IDA, intravenous ferric iron in doses ranging from 800 to 1,500 mg should be considered as first choice. In a few women with severe anemia and blunted erythropoiesis due to infection and/or inflammation, additional recombinant human erythropoietin may be considered. Blood transfusion should be restricted to women who develop circulatory instability due to postpartum hemorrhage. National health authorities should establish guidelines to combat iron deficiency in pregnancy and postpartum in order to facilitate a prosperous future for both mothers and children in a continuing globalized world.
本篇综述聚焦于分娩后女性（产后贫血）的贫血预防和治疗。产前和产后贫血问题在发展中国家远比在西方国家更为普遍。母婴在产后、哺乳期的状况应尽可能良好。许多年轻母亲由于缺铁和缺铁性贫血（IDA）导致多种症状，包括疲劳、身体残疾、认知问题和精神障碍，导致生活困难。应考虑将产后贫血常规筛查作为国家母婴健康计划的一部分。产后贫血的主要原因是产前铁缺乏和 IDA 加上分娩时失血过多。产后贫血应定义为产后 1 周时血红蛋白 <110g/l，产后 8 周时血红蛋白 <120g/l。出血超过正常约 300ml 的失血可能导致体内铁储备迅速耗尽，如果不治疗，可能会在产后引起长期缺铁和 IDA。产后贫血的预防应在妊娠早期开始，以确保分娩前有良好的铁状态。最可靠的方法是从妊娠早期开始每天口服 30-50mg 亚铁补充剂，并对有并发症风险的妊娠采取产科预防措施。在治疗轻度至中度产后 IDA 时，首选口服亚铁 100-200mg 每日；大约 2 周后分析血红蛋白至关重要，以检查治疗是否有效。在严重 IDA 时，应考虑静脉内给予 800-1500mg 的铁剂。对于由于感染和/或炎症导致严重贫血和红细胞生成受损的少数女性，可考虑额外给予重组人红细胞生成素。仅在因产后出血而出现循环不稳定的女性中才应考虑输血。国家卫生当局应制定打击妊娠和产后缺铁的指南，以促进在不断全球化的世界中母婴的美好未来。
