RE: [ozmidwifery] Haemoglobin and ferritin levels
Dear Sue The normal range of Ferritin in 10 to 150 - so 14 is in normal range. A lot of my clients have ferritin levels taken - and most of the time they are around 10 to 20 in the last trimester of pregnancy. Hb levels above 105 are also normal Cheers Jane Pregnancy, Birth and Beyond Caring, Professional Midwifery Services Sydney Visit http://www.pregnancy.com.au -Original Message- From: [EMAIL PROTECTED] [mailto:owner-ozmidwifery;acegraphics.com.au]On Behalf Of Sue Cookson Sent: Friday, 8 November 2002 10:03 PM To: [EMAIL PROTECTED] Subject: [ozmidwifery] Haemoglobin and ferritin levels Hi, Needing some help to clarify the difference between haemoglobin levels and ferritin levels. Have a local GP who switches between the two readings depending on which one is lowest and suggests/insists on iron injections. Levels I've had quoted from some of the women are: Hb 107 Ferritin 14 another: Hb 109 Ferritin 13 These two women are both 32 weeks. Just needing clarification and some evidence about the relevance of both/either readings. Hb levels seem fine to me - a bit foxed by the ferritin level - one woman had dropped from 120 early pregnancy to 14 now... Look forward to your fine input, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Haemoglobin and ferritin levels
In a message dated 8/11/02 10:05:31 PM AUS Eastern Daylight Time, [EMAIL PROTECTED] writes: Hi, Needing some help to clarify the difference between haemoglobin levels and ferritin levels. Have a local GP who switches between the two readings depending on which one is lowest and suggests/insists on iron injections. Levels I've had quoted from some of the women are: Hb 107 Ferritin 14 another: Hb 109 Ferritin 13 These two women are both 32 weeks. Just needing clarification and some evidence about the relevance of both/either readings. Hb levels seem fine to me - a bit foxed by the ferritin level - one woman had dropped from 120 early pregnancy to 14 now... Look forward to your fine input, Sue Hi Sue my understanding of the difference between the two is... Hb is the measurement of functional iron used in O2 transport and cellular respiration (just did my AP on blood and respiration :-)) ) and serum ferritin (SF) reflects the measurements of available storage levels of iron (as ferritin protein in plasma) therefore storage iron (SF) measurements could be used as indicators of iron 'stores' available for metabolic needs... It makes sense does it not then that SF levels would drop over the length of the pregnancy as iron stores were are utilised to accommodate increased metabolic needs in pregnancy and the growing baby??? I suppose the million dollar question is what is an acceptable drop in SF?? I can't help you with this bit :-) yours in reforming midwifery, Tina pettigrew. B Mid Student Victoria University
Re: [ozmidwifery] Haemoglobin and ferritin levels
Dear Lois So precise and concise A great revision for us all thank you Denise - Original Message - From: Lois Wattis [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, November 09, 2002 3:06 AM Subject: Re: [ozmidwifery] Haemoglobin and ferritin levels Haemoglobin is a pigment contained in the red blood cells which enables them to transport oxygen round the circulation. It is a compound of the ferrous-iron containing pigment haem combined with the protein globin. Each haemoglobin molecule contains 4 atoms of ferrous iron, 1 in each haem group, and can unite with 4 molecules of oxygen. Anaemia is a reduction in the number of red blood cells, or in the amount of haemoglobin present in them. Iron deficiency anaemia is the most common type of anaemia, probably related to poor nutrition, and is aggravated in early pregnancy due to the physiological haemodilution which occurs. The haemoglobin level (generally) used to indicate the presence of anaemia is 11.0 g/dl, considered the lower limit of the normal range (WHO, 1972) If the Hb level is below 9.0 g/dl further investigtions such as folate levels and serum ferritin may be necessary. Ferritin is the iron-apoferritin complex; one of the forms in which iron is stored in the body. Ferritin is the body's major iron-storage protein, ensuring that iron is readily available when demand is high, and is found in the liver, marrow and spleen. Serum ferritin falls in proportion to a decrease in iron store and is a more reliable test of iron status than haemoglobin level. Normal ferritin levels are 10-200 ug/l. Women who have low serum ferratin may need supplementation. The benefit of iron supplementation is now questioned and some studies show that the routine administration of iron may be superfluous or even harmful. Levels of haemoglobin traditionally regarded as pathological in the non pregant woman are in fact associated with good obstetric outcomes. The increase in plasma volume is essential to ensure perfusion of the vascular bed and maintenance of blood pressure and it is suggested that an increase in Hb may result in a decrease of blood flow through tissues. Routine iron supplementation in the absence of clinical indications is unnecessary The aim of iron supplementation in normal pregant women is not to elevate their Hb but to refill their iron stores. A low serum ferritin value is indicative of depleted iron stores and the need for iron supplementation. WHO considers anaemia to be present in pregnant women at 11 g/dl or less. More arbitrary levels may be decided locally and usually range between 10 and 10.5 g/dl. (Sweet, 1997, p549) Refer to pages 548-553 of Mayes Midwifery for detailed info. Sources: Mayes Midwifery 12th Edition (B. Sweet); Baillieres Midwives' Dictionary 9th Edition. Addit: Large studies indicate haemoglobin concentrations of 9 to 9.5g/dl are associated with optimal perinatal outcomes (as they reflect good plasma volume expansion) Odent, 1998, The Practising Midwife, Vol.1, Number 9. Sue, on the basis of this information, levels of 10 or above for either Hb or Ferritin do not necessarily warrant supplementation. The clinical condition of the woman also needs to be taken into account - is she tired, lethargic, dark circles under the eyes, pale inner eyelids? Breathlessness, especially on exertion, dizzy or faint? No silent bleeding occurring - eg haemorrhoids? How is her diet? Meat-eater or not? Leafy green veges? A holistic clinical assessment should accompany diagnostic tests. Regarding supplementation suggestions - Many midwives I encounter recommend Flurodix liquid which is a combination of iron, B C vitamins and herbs, minerals etc. which seems to work well for women low on iron, or manifesting any of the above symptoms. Taking zinc as well reduces the metallic after taste which some people complain about from Flurodix. Ferrum phos 6c (cell salts) helps with assimilation of dietary iron. Hope this is helpful. Best wishes, Lois Wattis - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, November 08, 2002 7:02 PM Subject: [ozmidwifery] Haemoglobin and ferritin levels Hi, Needing some help to clarify the difference between haemoglobin levels and ferritin levels. Have a local GP who switches between the two readings depending on which one is lowest and suggests/insists on iron injections. Levels I've had quoted from some of the women are: Hb 107 Ferritin 14 another: Hb 109 Ferritin 13 These two women are both 32 weeks. Just needing clarification and some evidence about the relevance of both/either readings. Hb levels seem fine to me - a bit foxed by the ferritin level - one woman had dropped from 120 early pregnancy to 14 now... Look forward to your fine input, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au
Re: [ozmidwifery] Haemoglobin and ferritin levels
Haemoglobin is a pigment contained in the red blood cells which enables them to transport oxygen round the circulation. It is a compound of the ferrous-iron containing pigment haem combined with the protein globin. Each haemoglobin molecule contains 4 atoms of ferrous iron, 1 in each haem group, and can unite with 4 molecules of oxygen. Anaemia is a reduction in the number of red blood cells, or in the amount of haemoglobin present in them. Iron deficiency anaemia is the most common type of anaemia, probably related to poor nutrition, and is aggravated in early pregnancy due to the physiological haemodilution which occurs. The haemoglobin level (generally) used to indicate the presence of anaemia is 11.0 g/dl, considered the lower limit of the normal range (WHO, 1972) If the Hb level is below 9.0 g/dl further investigtions such as folate levels and serum ferritin may be necessary. Ferritin is the iron-apoferritin complex; one of the forms in which iron is stored in the body. Ferritin is the body's major iron-storage protein, ensuring that iron is readily available when demand is high, and is found in the liver, marrow and spleen. Serum ferritin falls in proportion to a decrease in iron store and is a more reliable test of iron status than haemoglobin level. Normal ferritin levels are 10-200 ug/l. Women who have low serum ferratin may need supplementation. The benefit of iron supplementation is now questioned and some studies show that the routine administration of iron may be superfluous or even harmful. Levels of haemoglobin traditionally regarded as pathological in the non pregant woman are in fact associated with good obstetric outcomes. The increase in plasma volume is essential to ensure perfusion of the vascular bed and maintenance of blood pressure and it is suggested that an increase in Hb may result in a decrease of blood flow through tissues. Routine iron supplementation in the absence of clinical indications is unnecessary The aim of iron supplementation in normal pregant women is not to elevate their Hb but to refill their iron stores. A low serum ferritin value is indicative of depleted iron stores and the need for iron supplementation. WHO considers anaemia to be present in pregnant women at 11 g/dl or less. More arbitrary levels may be decided locally and usually range between 10 and 10.5 g/dl. (Sweet, 1997, p549) Refer to pages 548-553 of Mayes Midwifery for detailed info. Sources: Mayes Midwifery 12th Edition (B. Sweet); Baillieres Midwives' Dictionary 9th Edition. Addit: Large studies indicate haemoglobin concentrations of 9 to 9.5g/dl are associated with optimal perinatal outcomes (as they reflect good plasma volume expansion) Odent, 1998, The Practising Midwife, Vol.1, Number 9. Sue, on the basis of this information, levels of 10 or above for either Hb or Ferritin do not necessarily warrant supplementation. The clinical condition of the woman also needs to be taken into account - is she tired, lethargic, dark circles under the eyes, pale inner eyelids? Breathlessness, especially on exertion, dizzy or faint? No silent bleeding occurring - eg haemorrhoids? How is her diet? Meat-eater or not? Leafy green veges? A holistic clinical assessment should accompany diagnostic tests. Regarding supplementation suggestions - Many midwives I encounter recommend Flurodix liquid which is a combination of iron, B C vitamins and herbs, minerals etc. which seems to work well for women low on iron, or manifesting any of the above symptoms. Taking zinc as well reduces the metallic after taste which some people complain about from Flurodix. Ferrum phos 6c (cell salts) helps with assimilation of dietary iron. Hope this is helpful. Best wishes, Lois Wattis - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, November 08, 2002 7:02 PM Subject: [ozmidwifery] Haemoglobin and ferritin levels Hi, Needing some help to clarify the difference between haemoglobin levels and ferritin levels. Have a local GP who switches between the two readings depending on which one is lowest and suggests/insists on iron injections. Levels I've had quoted from some of the women are: Hb 107 Ferritin 14 another: Hb 109 Ferritin 13 These two women are both 32 weeks. Just needing clarification and some evidence about the relevance of both/either readings. Hb levels seem fine to me - a bit foxed by the ferritin level - one woman had dropped from 120 early pregnancy to 14 now... Look forward to your fine input, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Haemoglobin and ferritin levels
There is an excellent article on this in the Journal of Nurse Midwifery, I will have to ferret through some boxes to find it, just off the top of my head haemoglobin will neasure the amount of haemoglobin circulating in your blood and so the amount of iron and hence oxygen carried by your red blood cells, the ferritin levels will measure your iron stores necessary to make new red blood cells and can somewhat predict ones ability to reproduce your rbc'c after a haemorrhage: your recupperative capacity. Can't remember what the cut off levels are for ferritin. marilyn Original Message - From: Sue Cookson [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, November 08, 2002 3:02 AM Subject: [ozmidwifery] Haemoglobin and ferritin levels Hi, Needing some help to clarify the difference between haemoglobin levels and ferritin levels. Have a local GP who switches between the two readings depending on which one is lowest and suggests/insists on iron injections. Levels I've had quoted from some of the women are: Hb 107 Ferritin 14 another: Hb 109 Ferritin 13 These two women are both 32 weeks. Just needing clarification and some evidence about the relevance of both/either readings. Hb levels seem fine to me - a bit foxed by the ferritin level - one woman had dropped from 120 early pregnancy to 14 now... Look forward to your fine input, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
