Clarke Lisa, Froessler Bernd, Tang Catherine, King Kylie, Ross Bryony, Kidson-Gerber Giselle, Dugan Cory, Townsend Lynn, Uppal Talat, Baxter Laura, Cook Shab, Cutts Briony, Eslick Renee, Farrell Elizabeth, Grzeskowiak Luke, Hamad Nada
Transfusion Policy and Education, Sydney, Australian Red Cross Lifeblood, New South Wales, Australia.
Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2025 Feb;55(2):300-307. doi: 10.1111/imj.16602. Epub 2025 Feb 5.
Anaemia is a well-recognised and widely accepted consequence of iron deficiency (ID); however, the two diagnoses are not synonymous with the effects of ID occurring long before the development of anaemia. In adults, ID can cause physical and neuropsychological symptoms, including lethargy, altered mood and poor concentration, reducing an individual's quality of life. Foetal and neonatal ID has been associated with impaired neurocognitive development with lasting effects despite iron replacement in early life. Obstetric ID is common, affecting up to 70% of Australian pregnancies. The impact, at both an individual and a population level, remains underappreciated and consensus on the identification and management of obstetric ID is lacking. This consensus statement was developed by the Haematology in Obstetrics and Women's Health (HOW) Collaborative and utilised the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate evidence and strength of recommendations. Recommendations are as follows: (i) Routine ferritin screening should be performed in all pregnant women (GRADE 1C) at booking and 24-28 weeks. Repeat testing should be performed at 36 weeks if clinically indicated or if the woman is previously unscreened. (ii) ID in pregnancy should be defined as a ferritin level <30 μg/L (GRADE 1D). (iii) An appropriate oral iron formulation should be offered as first-line therapy for obstetric ID (GRADE 1B). (iv) Alternate-day oral dosing can be considered to limit side effects in women with obstetric ID (GRADE 2B). (v) Intravenous iron should be offered to women with ID/ID anaemia who are intolerant of or refractory to oral iron or in the third trimester (GRADE 1B).
贫血是缺铁（ID）公认且广泛接受的后果；然而，这两种诊断并非同义词，因为缺铁的影响早在贫血发生之前就已出现。在成年人中，缺铁会导致身体和神经心理症状，包括嗜睡、情绪改变和注意力不集中，从而降低个人生活质量。胎儿和新生儿缺铁与神经认知发育受损有关，尽管在生命早期进行了铁补充，但仍会产生持久影响。产科缺铁很常见，影响了多达70%的澳大利亚孕妇。在个体和人群层面上，其影响仍未得到充分认识，并且在产科缺铁的识别和管理方面缺乏共识。本共识声明由产科与女性健康血液学（HOW）协作组制定，并采用推荐分级评估、制定和评价（GRADE）系统来评估证据和推荐强度。推荐如下：（i）应在所有孕妇初次就诊时以及孕24 - 28周进行常规铁蛋白筛查（GRADE 1C）。如果有临床指征或该女性之前未接受筛查，则应在孕36周时重复检测。（ii）孕期缺铁应定义为铁蛋白水平<30 μg/L（GRADE 1D）。（iii）应提供合适的口服铁制剂作为产科缺铁的一线治疗（GRADE 1B）。（iv）对于产科缺铁的女性，可以考虑隔天口服给药以限制副作用（GRADE 2B）。（v）对于不耐受口服铁或对口服铁难治的缺铁/缺铁性贫血女性，或在孕晚期，应给予静脉铁剂（GRADE 1B）。
