ANTENATAL BOOKING

HB stat
HB11gm%
(NORMAL)
MCH27
OBIMIN 1/1
OD
SUGGESTED
OR
HAEMATINIC

ferrous
fumarate
200 mg
od

folic acid
5mg

vitamin
Bco 1 tab

vitamin C
100mg

HB 9-<11
(mild
anemia) ,
MCH 27
HAEMATINIC

ferrous
fumarate
400 mg
od/200mg
bd

folic acid
5mg

vitamin
Bco 1 tab

vitamin C
100mgOR
T. iberet 1/1
OD if pt not
tolerate with
ferrous
fumarate.
symptomatic
anemia need to
refer to MO/FMS.
repeat FBC every
month/more
frequent if
necessary.
if repeated Hb
result slightly
increase in the
following
month,observe pt
for another 1/12
with same
medication dose
if repeated Hb
result
static/decrease in
the following
month,refer doctor
- look for other
possibilities of
blood loss. Change
t. ferrous fumarate
to iberet 1 tab OD.
Poor compliance

HB 7-<9
(moderate
anemia)
MCH 27
HAEMATINIC

ferrous
fumarate 400
mg bd

folic acid 5mg

od

vitamin Bco 1/1

od

vitamin C 100
mg dailyOR

HB < 7
( severeanemia)
Refer pt to hospital
regardless the weeks

T.Iberet 2 tab od/1

tab bd if pt not
tolerate with t.
ferrous fumarate or
Hb does not
increasein the
following month.
lab investigation

Periheral blood
film(PBF)- if
macrocytic
anemia for
serum folate
and vitamin B
12.

iron study

HB
electrophoresis
if MCH<27

BFMP (if
indicated)

stool ova &cyst

Note

FBC- repeat
FBC 2 weekly/
more frequent
if nescessary

At 30 weeks if
poor
compliance/fail
to increase Hb

ALL FBC WITH MCH<27 NEED TO PROCEED WITH HB ELECTROPHORESIS

ALL PT WITH THALASEMIA NEED TO KEEP hb>7(SOSCG)-do serum iron IX before start haematinic & can start low dose ferrous
fumarate 200 od.
DAILY ELEMENTAL IRON REQUIREMENT= 30-60 mg , TREATMENT DOSE= 100-200 mg

iberet- elemental iron 105,vitamin C 500 mg

obimin- elemental iron 30,vitamin C 100 mg
ferrous fumarate- elemental iron 65

daily requiment for vitamin C :100mg , patient already on obimin /iberex no need to give another t. vitamin C
Please write Hb level and POG on the prescribtion.
advice pt to take medication with jus limau kasturi masam.
iberet only can be started by mo.
please change dosage accordingly to Hb level.
*pt on iberet 1bd/2od can reduced to 1od once Hb reading normalize.

formula to calculate amount of iron dextran needed

(normal Hb(11g%)-pt Hb in gram%)x BW(kg)x factor*+500mg =..Mg of

elemental iron

*FACTOR :iron dextran =0.24 (preparation available in PKKGU)

iron sucrose=2.4 ( available in PKKGU under AKK List)
EXAMPLE:
Pt BW: 60Kg Hb: 8
(11-8)x 60x0.24+500mg= 543.2 mg elemental iron (1 amp iron dextran 2ml=100mg)
pt requiment: 5 amp 550mg
everyday give1 amp for 5 -6 days.

OR
10 amp. for 10 days(1 amp every day).
note:
*repeat Hb 2/52 after last dose given
do not give oral haematinic/iberet if pt on im detran, restart oral
haematinic/iberex if im dextran completed.
test dose 0.5mls(undilutes solution).
need to performed in fasilities with adequate resuscitation equipment.

ALL FBC WITH MCH<27 NEED TO PROCEED WITH HB ELECTROPHORESIS

ALL PT WITH THALASEMIA NEED TO KEEP hb>7(SOSCG)-please do serum iron IX
before start haematinic&can start low dose ferrous fumarate 200 od.
DAILY ELEMENTAL IRON REQUIMENT= 30-60 , TREATMENT DOSE= 100-200 mg

iberet- elemental iron 105,vitamin C 500 mg

obimin- elemental iron 30,vitamin C 100 mg
ferrous fumarate- elemental iron 65

dailyrequiment for vitamin C :100mg , patient already on obimin /iberetno need

to give another t. vitamin C
please write Hb level and POG at the prescription.
advice patient to take haematinic together with jus limaukasturimasam.