This is an official Northern Trust policy and should not be edited in any way

Please note that the policy library on Staffnet will contain the most up to date version of Trust policies
Reference No: NHSCT/18/1204
Title: Anaemia and Vitamin Supplementation in Pregnancy
Key words within Anaemia, Haemoglobin, iron, ferritin, pregnancy
policy (max 10 words):
Policy Author(s): Louisa Lapworth, Deputy Sister OPD4
Cathy Hamilton, Practice Development Midwife
Responsible Director: Marie Roulston, Divisional Director of Women, Children and Families
Division
Policy Type: Trust Wide ☐ Division Specific ☒ Clinical and/or social care ☒
Policy Replacement: Yes ☒ No ☐ Anaemia and Vitamin Supplementation in
Pregnancy - NHSCT/14/755
Directors/Divisions Nursing ☐
policy to be issued to: Medicine ☐
Finance ☐
Medicine and Emergency Medicine ☐
Human Resources, Organisational Development and Corporate
Communications ☐
Community Care ☐
Surgical and Clinical Services ☐
Mental Health, Learning Disability and Community Wellbeing ☐
Women, Children and Families ☒
Strategic Development and Business Services ☐
Target Audience, ie, This guideline is directed to midwives, obstetricians and other staff
specific staff groups working with pregnant women in both the hospital and community
setting.
Approved by: Dr Kate Scott & Mrs Suzanne Pullins 4 May 2018
Co-chairs, Clinical and Social Care Policy and Appendix 4 - document
Guidelines Committee link revised, 18 Dec 2018
Operational Date: 23 May 2018 Review Date: 30 November 2020
Policy Library Clinical and Social Care - Hospital (incl Comm Hosp) ☐
Categories: Clinical and Social Care - Children’s Hospital & Community ☐
(Please tick as Clinical and Social Care - Community ☐
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Palliative Care ☐ Major Incident Plan ☐
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NHSCT Vision
To deliver excellent integrated services in partnership with our community.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 1 of 22

Anaemia and Vitamin Supplementation in Pregnancy

Contents

1.0 Summary of policy 3

2.0 Responsibilities 3

3.0 Policy Statement 4

Booking to 28 weeks flowchart 5

28 weeks and onwards flowchart 7

Intrapartum management 8

Postnatal management 8

Vitamin Supplementation in Pregnancy 9

4.0 Monitoring 13

5.0 Evidence Base/References 13

6.0 Personal and Public Involvement (PPI)/Consultation Process 14

7.0 Equality, Human Rights & DDA 14

8.0 Alternative Formats 14

9.0 Sources of advice 15

10.0 Policy Sign off 15

11.0 Appendices 16-22

11.1 Appendix 1: Oral Iron Preparations in common use 16

11.2 Appendix 2: Monofer®, Venofer and Ferinject® 17

11.3 Appendix 3: MHRA Drug Safety Update 20

11.4 Appendix 4: Patient Information Leaflet “Iron in your diet” 22

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 2 of 22

1.0 Summary of Policy

Iron deficiency anaemia is the most common anaemia in pregnancy.

Routine Iron administration to the non anaemic pregnant woman

1
(Haemoglobin (Hb) >110g/l) is not recommended.

The purpose of this guideline is to provide all healthcare professionals with

clear recommendations for the diagnosis, treatment and prevention of
anaemia in pregnancy and the postpartum period.

2.0 Responsibilities

Directors are responsible for the dissemination and implementation of this

guidance within the divisions/directorates.

Line managers are responsible for ensuring that staff have a working
knowledge of and adhere to the guidance and that any amendments are
disseminated.

All practitioners are responsible for familiarising themselves with and adhering
to this guidance.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 3 of 22

3.0 Policy Statement

Anaemia is defined by;

First trimester Hb < 110g/l

Second & Third trimester Hb < 105g/l
Postpartum Hb < 100g/l
(United Kingdom guidelines on the management of iron deficiency in
pregnancy1 2011)

Antenatal Investigation & Management

During the antenatal period all women should be given written dietary
information to maximise iron intake and absorption 2.

Haemoglobin (Hb) should be routinely checked:

 Booking visit
 28 weeks onwards
 Consider post-natal Hb check as indicated e.g. women with history of
post-partum haemorrhage (PPH), uncorrected antenatal (A/N) anaemia
or symptomatic

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 4 of 22

 Booking to 28 weeks

Hb < 110g/l (booking appointment)

Letter to woman informing her to collect prescription from General Practitioner (GP). Dietary a
Letter to GP requesting prescription for oral combined iron preparation such as Pregaday® 1

Midwife/GP rechecks Hb after 4 weeks of oral iron sup

Hb increasing

No:
Yes & compliance good:
Check compliance; consider alternative prepa
Continue oral iron
Check ferritin levels (ochre-topped bottle and

Ferritin > 15ug/l

If ferritin
seek< 15ug/l
advice and
fromoral
Haematologist
iron intolerant,Ifunresponsive
ferritin < 15ug/l
or non-compliant,
and oral iron t
Seek advice* See
from Appendix
named Consultant
2 if abnormal B12Recheck
and folate
Hb after 4 weeks

If compliance poor - consider alternative combined iron therapies or liquid

Hb preparation
improving: as possible optio
Yes = Continue oral iron
No = Consider intravenous iron

The professional who initiates a test is responsible for ensuring that any necessary follow up actio
SQR/SAI/2017/023 (MCH & PHC)
 

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 5 of 22

  Women should be informed as to how to take oral iron supplements
correctly. This should be on an empty stomach, 1 hour before meals,
with a source of vitamin C (ascorbic acid) such as orange juice to
maximise absorption. Other medications or antacids should not be
taken at the same time.
 Women with established iron deficiency anaemia should be given ferrous
sulphate 200mg twice daily for 2 weeks (this is equivalent to 130mg
elemental iron – Appendix 1). They should be advised on correct
administration to optimise absorption.
 Dietary changes alone are insufficient to correct iron deficiency anaemia
and iron supplements are necessary. Ferrous iron salts are the
preparation choice (see Appendix 1). The oral dose for iron deficiency
anaemia should be 100-200mg of elemental iron daily.
 For nausea and epigastric discomfort, preparations with lower iron content
should be tried. Slow release and enteric coated forms should be avoided.
(Serum ferritin is a stable glycoprotein which accurately reflects iron stores
in the absence of inflammatory change. It is the first laboratory test to
become abnormal as iron stores decrease and it is not affected by recent
iron ingestion. The serum ferritin level is the most useful and easily
available parameter for assessing iron deficiency. Levels below 15 μg/l are
diagnostic of established iron deficiency.)

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 6 of 22

 28 weeks and onwards

Hb < 105g/l at 28 weeks and onwards

Letter to woman with dietary advice (Appendix 4) and request to collect prescription from GP.
Letter to GP requesting prescription for oral combined iron preparation such as Pregaday® 1 da

Midwife/GP rechecks Hb after 4 weeks of oral iron supplem

If improving:
Continue oral iron

If not improving: check compliance and consider alternative p

Check ferritin levels, B12 and folate

If ferritin < 15ug/l, Ferritin > 15ug/l seek advice

Discuss with lead professional and consider *intravenous iron (Monofer ®)

If abnormal B12 and folate res

* See Appendix 2

The professional who initiates a test is responsible for ensuring that any necessary follow up actions are
Community midwife follow-up with ferritin < 15 - consider discussion with Consultant of Week prior to re

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 7 of 22

 Intrapartum management

Anaemic women require additional precautions for delivery, including

 delivery in a hospital setting,
 available intravenous access,
 blood group and save/cross-match,
 active management of the third stage of labour,
 plans for management of excessive bleeding
 think about weighing of swabs for estimation of blood loss.
 If a woman requests a home birth and becomes anaemic during the
ante natal period , the risks should be discussed with her and a care
plan put in place to address the above issues within a home setting

Postnatal management

Postpartum women with estimated blood loss >500ml, uncorrected anaemia

detected in the antenatal period, or symptoms suggestive of anaemia
postnatally should have Hb checked within 48 hours and dietary advice.

Women who are haemodynamically stable, asymptomatic or mildly

symptomatic, with Hb <100 g/l should be offered elemental iron 100-200mg
daily for 3 months with a repeat Full Blood Picture (FBP) and ferritin at the
end of therapy to ensure Hb and iron stores are replete.

The decision to transfuse women in the postpartum period should be based

on careful evaluation including whether or not there is risk of bleeding, cardiac
compromise or symptoms requiring urgent attention, considering oral or
parenteral iron therapy as an alternative.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 8 of 22

 Vitamin Supplementation in Pregnancy

Vitamins are organic compounds essential for normal cell function, growth
and development. There are 13 essential vitamins: vitamins A, C, D, E, K and
the B series including B1 (thiamine), B2 (riboflavin), B3 (niacin), B5
(pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid), B12
(cobalamin).

Folic Acid Supplementation

The National Institute for Health and Clinical Excellence (NICE) guideline,
Antenatal Care: Routine Care for uncomplicated pregnancies 2, advises folic
acid supplementation at a dose of 400 micrograms/day before conception and
up to 12 weeks of gestation. There is insufficient evidence to confirm or refute
the benefits of folic acid supplementation in developed countries beyond 12
weeks of gestation with the aim of improving other perinatal outcomes.

Folic Acid and Neural Tube Defects

Combined preparations
Pregaday® Elemental Iron 100mg Folic acid 350 micrograms
®
Fefol Elemental Iron 47mg Folic acid 500 micrograms
®
Galfer FA Elemental Iron 100mg Folic acid 350 micrograms
Pregnacare® Elemental Iron 17mg Folic acid 400 micrograms Vit. D
10 micrograms

Folic acid supplements taken before and during pregnancy can reduce the
occurrence of neural tube defects. The risk of a neural tube defect occurring
in a child should be assessed and folic acid given as follows:

 Women at a low risk of conceiving a child with a neural tube defect

should be advised to take folic acid as a medicinal or food supplement
at a dose of 400 micrograms daily before conception and until week 12

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 9 of 22

 of pregnancy. 2 Women who have not been taking folic acid and who
suspect they are pregnant should start at once and continue until week
12 of pregnancy.

 Couples are at a high risk of conceiving a child with a neural tube

defect if either partner has a neural tube defect (or either partner has a
family history of neural tube defects), if they have had a previous
pregnancy affected by a neural tube defect, or if the woman has coeliac
disease (or other malabsorption state), diabetes mellitus, sickle-cell
anaemia, or is taking antiepileptic medicines .

 Women in the high-risk group who wish to become pregnant (or who
are at risk of becoming pregnant) should be advised to take folic acid 5
4
mg daily from pre-conception and continue until week 12 of pregnancy
(women with sickle-cell disease should continue taking their normal
dose of folic acid 5 mg daily (or to increase the dose to 5 mg daily) and
continue this throughout pregnancy).

 Women with a BMI ≥30 wishing to become pregnant should be advised

to take 5mg folic acid supplementation daily, starting at least one month
before conception and continuing throughout the first trimester of
pregnancy.5

Vitamin A Supplements

Although there is considerable interest in the role of vitamin A

supplementation in reducing night blindness, anaemia and all-cause maternal
mortality in the developing world, where deficiency of this vitamin is common,
there are no data to support supplementation in the UK. High-dose vitamin A
supplementation is not recommended in developed countries, owing to the
potential teratogenic effects particularly affecting cranial neural crest cells.
NICE antenatal guidelines state that ‘vitamin A supplementation (intake above
700 micrograms) and liver products…should therefore be avoided’

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 10 of 22

 Vitamin K1
Enzyme inducing antiepileptic drugs:
 Carbamazepine
 Oxcarbazepine
 Phenobarbitone
 Phenytoin
 Primidone
 Topirimate
(NB some anti-epileptic drugs may be prescribed by brand name)
are known to cross the placenta and promote oxidative degradation of vitamin
K1 in the fetus
However, it is no longer regarded as necessary to use supplements with
3
vitamin K for women prescribed anti-epileptic drugs antenatally.

Vitamin C, B and E

There is no strong evidence to support routine vitamin B6 supplementation in

pregnancy.

There is no evidence from randomised controlled trials to support

supplementation with any of vitamins Vit B1 (thiamine), 2 (riboflavin), 3
(Niacin), 5 (pantothenic acid, 7 (Biotin), 12 (Cobalamin) in pregnancy.

Vitamin C is commonly included in low doses (less than 200 mg/day) within
multivitamin preparations for pregnancy but has also been given in higher
doses (up to 1000 mg/day) as a supplement, alone or in combination with
vitamin E. Routine supplementation with higher doses of Vit. C and E are not
recommended.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 11 of 22

 Vitamin D

The Scientific Advisory Committee published a report on Vitamin D intake on

21 July 20166 .
Vitamin D is required for regulation of calcium and phosphorus metabolism
and is therefore important for musculoskeletal health. It is synthesised in the
skin upon exposure to sunlight containing sufficient ultraviolet B (UVB)
radiation and this is the main source for most people. It can also be obtained
from foods or dietary supplements. Dietary sources are essential when
sunlight containing UVB radiation is limited (e.g., during the winter months) or
exposure to it is restricted (e.g., due to lack of time spent outdoors or little skin
exposure).

The Reference Nutrient Intakes (RNI) of 10 μg/d (400 IU/d) proposed for the
general UK population (aged 4years and above) includes pregnant and
lactating women and population groups at increased risk of having a serum
25(OH)D concentration < 25 nmol/L. A separate RNI is not required for these
groups. This is a change from previous advice.7,8

From October to March everyone over the age of five, including pregnant and
breastfeeding women, should consider taking a daily supplement containing
10 micrograms of vitamin D7,8 to ensure the mother’s requirements for vitamin
D are met and to build adequate fetal stores for early infancy.

Pre-pregnancy obesity is also associated with significant increases in the

odds of maternal and neonatal vitamin D deficiency, independent of other
factors such as ethnicity.

Pregnacare® once daily is the medication that contains the required Vitamin D
(10 micrograms) and folate (400 micrograms) requirement.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 12 of 22

4.0 Monitoring
To be included in audit programme.
Adverse drug reactions to be reported.

5.0 Evidence Base/References

1. British Committee for Standards in Haematology (2011). UK guidelines on

the management of iron deficiency in pregnancy

2. National Institute for Health and Care Excellence. CG62 Antenatal Care for
uncomplicated pregnancies.
https://www.nice.org.uk/guidance/cg62/resources/antenatal-care-for-
uncomplicated-pregnancies-pdf-975564597445

3. UK epilepsy and pregnancy register.

Contact: Beth Irwin, Named Midwife for Women with Epilepsy, Royal Jubilee
Maternity Services. BHSCT, Belfast.

4. National Collaborating Centre for Women’s and Children’s Health.

Diabetes in Pregnancy; management of diabetes and its complications from
pre-conception to the postnatal period. London: RCOG Press; 2008.

5. Management of Women with Obesity in Pregnancy, CMACE/RCOG Joint

Guideline. March 2010

6. Public Health England (2016) The Scientific Advisory Committee on

Nutrition (SACN) recommendations on vitamin D.
https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report

7. Public Health Authority (2016). Folic acid and Vitamin D guidelines for
health professionals http://www.publichealth.hscni.net/publications/folic-acid-
and-vitamin-d-guidelines-health-professionals

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 13 of 22

 8. HSS (MD) 5/2017: New advice on Vitamin D intake.
http://www.publichealthagency.org/publications/vitamin-d-and-you-0

9. MHRA Drug Safety update 7 August 2013. www.mhra.gov.uk

10. Northern Ireland Formulary, HSC Board.

http://niformulary.hscni.net/Formulary/Adult/9.0/9.1/9.1.1/Pages/default.aspx

11. HSC/PHA (2017). Safety & Quality Reminder of best practice guidance.
SQR/SAI/2017/023 “Sepsis due to untreated urinary tract infections in
pregnancy.”
http://insight.hscb.hscni.net/download/safety_quality_and_learning/sqr_best_p
ractice_reminder_letters/SQR-SAI-2017-023-MCH-PHC-Sepsis-due-to-
untreated-urinary-tract-infections-in-pregnancy.pdf

6.0 Personal & Public Involvement (PPI)/Consultation Process

Haematology, pharmacy department and senior Midwifery and Obstetric

Teams have been consulted during the updating process for this Clinical
Guideline.

7.0 Equality, Human Rights & DDA

This policy has been drawn up and reviewed in the light of Section 75 of the
Northern Ireland Act (1998) which requires the Trust to have due regard to the
need to promote equality of opportunity. It has been screened to identify any
adverse impact on the 9 equality categories.

The policy has been ‘screened out’ without mitigation or an alternative policy
proposed to be adopted.

8.0 Alternative Formats

This document can be made available on request on disc, larger font, Braille,
audio-cassette and in other minority languages to meet the needs of those
who are not fluent in English.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 14 of 22

9.0 Sources of advice in relation to this document

The Policy Author, responsible Assistant Director or Director as detailed on

the policy title page should be contacted with regard to any queries on the
content of this policy.

10.0 Policy Sign Off (Typed name/scanned signature sufficient)

Louisa Lapworth
Cathy Hamilton 18th May 2017
Lead Policy Authors Date

Mrs Fiona Brown 28th Sept. 2017

Assistant Director Date

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 15 of 22

Appendices 11.0

Appendix 1

Oral Iron Preparations in common usage

Ferrous Fumarate (Galfer®) comes as 210mg; 322mg and 305mg. Northern Trust
stock the:

a. 322mg which is Fersaday® and is equivalent to 100mg iron

b. 305mg which is Galfer® and is equivalent to 100mg iron

Ferrous Sulfate 200mg (elemental Iron 65mg)

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 16 of 22

Appendix 2
(For all Intravenous Iron Preparations please also note Appendix 3)
USE OF MONOFER® INJECTION IN IRON DEFICIENCY ANAEMIA

Patients requiring Monofer® infusions will attend;

 Antrim Fetal Maternal Assessment Unit (FMAU) on Monday and Thursday
mornings at 08.00hrs
 Causeway FMAU at pre-arranged date & time

Patients should have received an information leaflet prior to attendance. The SHO
on call overnight will calculate and prescribe the dose of Monofer ® required as per
the equation below.

British Committee for Standards in Haematology (2011) state target Hb should be

110g/L.

Step 1: Calculate iron requirement:

- Patient’s iron need depends on Hb level and body weight (USE BOOKING
WEIGHT).
-

Use Ganzoni formula to calculate iron need and round to nearest 100mg Using
Ganzoni formula the Iron need (in mg iron) is equal to

Worked example:

Pre-pregnancy (booking) weight = 70kg

Target Hb = 110 g/L Actual Hb = 90g/L

10 x pre-pregnancy weight = 700

Total iron need = 70 x (110-90) x 0.24 + 700 = 1036mg iron

Therefore rounding to nearest 100mg = give 1000mg of MONOFER®

Body Weight (kg) x (Target Hb (g/L) – Actual Hb (g/L)) x 0.24 + (10mg/kg)

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 17 of 22

Step 2: Administration:

- No test dose is required

- Give as Intravenous (IV) Infusion in 250ml 0.9% Sodium Chloride over 30
minutes

Doses greater than 20mg/kg must be given as split doses. Administer

maximum dose at first visit, second administration based on clinical
judgement, at least one week after first visit.

Step 3: Monitoring:

The patient should be observed prior to infusion, during infusion and for at least 30
minutes following each Monofer® injection for signs and symptoms of hypersensitivity
reactions9 (Appendix 3).

NOTE
Monofer® is not licensed for use in patients under 18 years old – Ferinject ® is
available for these patients.
Caution should be advised in patients with severe asthma – use in discussion with
Consultant

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 18 of 22

Venofer® (iron hydroxide sucrose)

 2 Ampoules (200mg of Venofer) in 200mls of 0.9% Sodium Chloride (N/Saline) for every
patient on alternate days for 3 doses only.
 100mls per hour for 15 minutes as test Dose. Have adrenaline® (SC), Piriton® and
Hydrocortisone available.
 200mls / hour until finished

Observations as per blood transfusion

Observe for one hour after completion.

An alternative therapy which requires a once only regimen is:

Ferinject ® (Iron carboxymaltose)

Standard dose: 1000 mg (2 X 10mls vials) in 250 mls 0.9% Sodium Chloride intravenous at
the rate of 1000ml/ hr.
No test dose required. (Low antigenic properties, thus anaphylaxis is extremely rare)
Minimum administration time: 15 minutes.
Follow up: Arrange recheck haemoglobin after 2-4 weeks of having intravenous iron.

®
Midwifery Procedure for infusion of Ferinject (by permission of Ulster Hospital,
Dundonald)
 Record baseline observations; temperature, pulse and blood pressure.
 Prepare infusion of Ferinject ®
 Have anaphylaxis pack in clinical area
 Prepare skin with a sterett
 Insert Cannula and secure with a dressing
 Take blood sample for FBP if requested
 Flush Cannula with 2mls 0.9% Sodium Chloride
 Commence infusion of Ferinject ®
 Observe mother for any adverse effects
 Remove Cannula after infusion complete.

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 19 of 22

 Record pulse and blood pressure post infusion

Appendix 3
The following is an MHRA Drug Safety Update (Sept. 2013) following
hypersensitivity reactions to IV Iron in France)

Advice for healthcare professionals:

The prescribing, dosing, administration, and safety information differs between IV

iron product formulations, and the individual product information should be consulted
before and during use.

Prescribing

 An IV iron product should not be used in patients with known hypersensitivity

to the active substance, the product itself, or any of its excipients; it should
also not be used in patients with known serious hypersensitivity to any other
parenteral iron product
 The risk of hypersensitivity is increased in patients with: known allergies
(including drug allergies); immune or inflammatory conditions (e.g., systemic
lupus erythematosus, rheumatoid arthritis); or those with a history of severe
asthma, eczema, or other atopic allergy. In these patients, IV iron products
should only be used if the benefits are clearly judged to outweigh the potential
risks
 IV iron should not be used during pregnancy unless clearly necessary.
Treatment should be confined to the 2nd or 3rd trimesters, if the benefit is
clearly judged to outweigh the potential risks for both mother and foetus

Administration and monitoring

 IV iron should be administered in strict accordance with the posology and

method of administration described in the product information for each
individual product (note that advice varies between products)
 Caution is needed with every dose of intravenous iron that is given, even if
previous administrations have been well tolerated
 IV iron products should only be administered when staff trained to evaluate
and manage anaphylactic or anaphylactoid reactions—as well as
resuscitation facilities—are immediately available
 Patients should be closely monitored for signs of hypersensitivity during and
for at least 30 minutes after every administration of an IV iron product

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 20 of 22

  In the event of a hypersensitivity reaction, treatment should be stopped
immediately and appropriate management initiated

Information for patients

 Healthcare professionals should inform patients of the risk and potential

seriousness of a hypersensitivity reaction before every administration.
Patients should be informed of the relevant symptoms and advised to tell their
doctor or nurse straight away if any of these occur

Reporting of suspected adverse drug reactions

 The safety of IV iron products will continue to be monitored closely in the UK

and Europe. You can help by reporting via the Yellow Card Scheme any
suspected adverse reactions to IV iron products. We are particularly
interested in reports of suspected anaphylactic or anaphylactoid
hypersensitivity reactions. Please ensure to include the name of the specific
product administered (www.mhra.gov.uk/yellowcard)

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 21 of 22

Appendix 4
NHS Blood and Transplant (2016) “Iron in your diet” Patient Information leaflet

Iron In Your Diet.pdf

Anaemia and Vitamin Supplementation in Pregnancy Version 2_1 Page 22 of 22