Wednesday, July 11, 2007

Pregnancy-related Anemia

I think I mentioned before that I found out at my last OB appointment that my blood tests indicated I was anemic. So, even though they discovered this 6 weeks prior, they didn't bother telling me about it until my next appointment. Upon research, I have discovered the following things which really cause me to be extra ticked off that they didn't call me:

1. If you remain anemic during the first two trimesters, you're at a higher risk for having a preterm delivery or a low-birthweight baby, so it is something to take seriously. And if you're severely deficient, it could affect your baby's iron stores at birth, increasing his risk for anemia later in infancy.
Iron-deficiency anemia affects your health as well. It can sap your energy and make it harder for your body to fight infection. And if you're anemic later in pregnancy, you're more likely to have problems if you lose a lot of blood when you give birth. You may feel dizzy, have a rapid heart rate, or have other symptoms that require you to stay in the hospital an extra day or two. You're also more likely to need a blood transfusion.
Info taken from here.

2. Once the patient is started on oral iron therapy, it takes about 6 - 10 weeks for hemoglobin to return to normal level. However in IDA, iron stores are exhausted and need to be replenished. Replenishment of iron stores begins only after hemoglobin returns to normal. Hence stopping iron soon after hemoglobin is normal means inadequate therapy and predisposes patient to recurrence. Absorption of iron diminishes after hemoglobin returns to normal and hence replenishing iron stores is a very slow process and takes about 3 - 4 months. Thus iron therapy should be continued for 5 - 6 months. Info taken from here.

So basically, even though it takes at least 6 weeks for levels to begin returning to normal, they didn't bother calling me to allow me that extra 6 weeks of time. Since I didn't start on the iron supplements until I was 16 weeks pregnant, that means I will be 22 weeks pregnant before my levels start rising back to normal. I will be approaching (or in) my third trimester by the time my levels are back to where they should be. So thanks to the stupid clinic not bothering to call me, I could technically remain anemic for the first 2 trimesters, which puts me at risk for pre-term labor and a low birth weight baby. And possibly a blood transfusion, since I assume I'll lose a decent amount of blood with the c-section. Wonderful, thank you so much. I swear I just want to slap someone in that office.

Now, I don't know what my levels were - she just said my CBC came back low. I didn't know enough at the time to ask for specifics. Hey, to me low is low, and if they thought it was low enough to put me on an extra 130mg of iron a day (65mg twice daily), on top of what is in my prenatals, then it must have been fairly low. And of course, just because the bad things are possible, it doesn't mean they will happen. But still, doesn't this seem like something that they should have contacted me about? The policy at the clinic is that they will only call you if there is something wrong with your test results - they specifically tell you that if you don't hear from them, it means everything came back normal. Obviously everything wasn't normal, yet they didn't feel the need to call me. Or more likely, nobody thought of it, since you see a different doctor or nurse every time so your chart just gets passed around.

So, now I have to time my life around these pills - They are to be taken on an empty stomach and I can't have dairy, coffee, tea, among other things, for at least an hour before and 2 hours after I take them, so my meals are being planned around my pills. Great side effects too - stomach cramps, constipation, wonderful stuff. Of course, it is all worth it for my baby, but I must say I miss my 2-3 times a week coffee and I am darned sick of being exhausted all the time. I hope those levels set a record in returning to normal fast! Not that I expect the clinic to even bother checking.....

So, does anyone have any info about this whole anemia in pregnancy? Anything to enlighten me, or to make me feel less concerned?

Sorry for all the bitching, but I'm just a little peeved at my clinic right now. On top of all this anemia crap, I went to have bloodwork done, and now I find out they didn't do all the tests they were supposed to because the doctor forgot to put one in. SO now I have to go back, driving 45 minutes each way and waiting up to an hour for my turn, and give blood again so I can get the triple screen, or quad screen, whatever it is called. My veins are not good, and I seem to always get the newbie who can't get my one good vein so insists on poking around at several others before finally agreeing to let someone else do it. Even though I always tell them straight off that I only have that one good vein and many have tried and many have failed at getting any other vein. Argh!


furrow said...

Geez! That's unexcusably negligent. If something goes wrong because of this, it certainly seems you would have grounds to take some action against the clinic. I don't blame you for being totally pissed. What did your doctor have to say about it?

Chris said...

That absolutely sucks!

And what is it with those lab techs that look at crappy veins as a challenge? We should be allowed to use them as a dart board and see how THEY like it.

Hope you're feeling good and the side effects are minimal.

OHN said...

It DOES piss you off completely when things get screwed up. Sadly it happens ALL THE TIME. All of my clients are physicians and I see/hear about some of the lapses in protocol all too frequently. It is almost always human error and typically by someone that is making $6.50 an hour and hates their job enough to really care. I would write a strong letter to the owning partners of the practice (a copy to each) and anyone that is above them such as the hospital (of they are a hospital based group). These types of mistakes cannot be overlooked and while hopefully it won't cause you any harm, it could the next patient. So, in fact you are doing them a favor by telling them that someone in their staff is a duffus. It may prevent them from a large lawsuit someday! (Sorry, this topic gets me all riled up:)

Michelle said...

For anyone else that reads this, I suggest the iron infusion. They put iron in through an IV and it works after 2 weeks instead of 6. Plus it has less side effects.

Ashley said...

I ws just in the hospital for an emergency cerclage. (19 weeks). While there I had a friend with me who works in the medical field. We looked at my chart and discovered that I was anemic. Nobody mentioned it and I forgot. 2 weeks later I am light headed, dizzy, exhausted, (more than the bed rest should warrant). I looked it up and read that anemia is common yet not good during the 2nd trimester.
I mentioned to my friend that anemia was likely the reason that I experienced all these symtpoms anf she remionded me of wht was in my chart. Nobody told me anything.I even had a follow up visit with the doctor.

I am thinking that it is a common practive to neglect simple things in the chart. I have an appt on Thursday and you can bet I will birng it up. I am a high risk preganacy-and they havent even mentioend anything about something that *could* cause preterm labor???? Thanks for your post. It opened my eyes.