How To Improve Hemoglobin Level During Pregnancy?

How To Improve Hemoglobin Level During Pregnancy
Preventing Anemia –

Eat iron-rich foods such as meat, chicken, fish, eggs, dried beans and fortified grains. The form of iron in meat products, called heme, is more easily absorbed than the iron in vegetables. If you are anemic and you ordinarily eat meat, increasing the amount of meat you consume is the easiest way to increase the iron your body receives. Eat foods high in folic acid, such as dried beans, dark green leafy vegetables, wheat germ and orange juice. Eat foods high in vitamin C, such as citrus fruits and fresh, raw vegetables. Cooking with cast iron pots can add up to 80 percent more iron to your food. Take your prenatal multivitamin and mineral pill which contains extra folate.

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Does low hemoglobin affect baby during pregnancy?

How does anemia affect the baby during pregnancy? – Your unborn baby relies on you to get enough iron, vitamin B12 and folic acid. Anemia can affect the growth of your baby, especially during the first trimester. If anemia goes untreated, your baby is at higher risk of having anemia after birth, which can lead to,
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How much hemoglobin is normal during pregnancy?

I NTRODUCTION – In the past three decades, the relationship between maternal hemoglobin and hematocrit levels and pregnancy outcome has been generally studied. Maternal anemia has been considered as a risk factor for an undesirable pregnancy outcome. On the other hand, the relationship between high levels of hemoglobin and hematocrit and the complications such as preterm delivery, low birth weight, intrauterine growth restriction and intrauterine fetal death have been also shown in several studies.

  1. According to the study of Stove et al.
  2. Conducted on Bulgarian pregnant women, increase of hematocrit, hemoglobin and red cell mass in early pregnancy can be considered a risk factor for preeclampsia, intrauterine growth restriction and fetal death in the later stages of pregnancy.
  3. Measuring hemoglobin and hematocrit is common during pregnancy.

Normal level of hemoglobin is 12 to 16 grams per deciliter for women of childbearing age. Its minimum normal value is 11 grams per deciliter in the first and third trimester of the pregnancy and 10.5 grams per deciliter in the second trimester. Its amount gets lower than normal due to anemia and higher than normal because of erythrocytosis.

  1. Normal values of hematocrit have been determined from 36 to 48 percent for women in childbearing age.
  2. The cause of its decrease in adults and during pregnancy is anemia, and the reasons for its increase are myeloproliferative disorders, chronic obstructive pulmonary disease and other hypoxic lung conditions.

Both hemoglobin and hematocrit are measured through fresh whole blood and are dependent on plasma volume. Thus, factors such as dehydration as well as overhydration can affect the test results. In fact, hematocrit is a more precise parameter than hemoglobin to determine the ratio of erythrocyte volume to the total blood volume.

  • Viscosity of blood is changeable, which is associated with geometry of blood vessels and blood flow level, blood plasma concentration, volume concentration of blood cells and hematocrit.
  • Therefore, change in the mentioned parameters can be a warning of a high-risk pregnancy.
  • The relationship between ferritin level and pregnancy outcome as well as the relationship between the hematocrit levels provide grounds for more investigation especially considering that such a study has not yet been done in Iran.

Our purposes were to examine the relationship of hemoglobin and hematocrit during the first and second half of pregnancy with pregnancy outcome including premature rupture of membranes (PROM) before the onset of labor, preterm premature rupture of membranes (PPROM) before completion of the thirty-seventh week of pregnancy, preeclampsia, delivery type and birth anthropometric indicators.
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What raises hemoglobin quickly?

1. Increasing iron intake – A person with reduced levels of hemoglobin may benefit from eating more iron-rich foods. Iron works to boost the production of hemoglobin, which also helps to form more red blood cells. Iron-rich foods include:

meat and fishsoy products, including tofu and edamame eggsdried fruits, such as dates and figsbroccoligreen leafy vegetables, such as kale and spinachgreen beansnuts and seedspeanut butter

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How can I overcome low hemoglobin during pregnancy?

How is iron deficiency anemia during pregnancy treated? – If you are taking a prenatal vitamin that contains iron and you are anemic, your health care provider might recommend testing to determine other possible causes. In some cases, you might need to see a doctor who specializes in treating blood disorders (hematologist).
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What causes hemoglobin to drop in pregnancy?

Causes of Anemia during Pregnancy – The cause of anemia truly comes down to how many red blood cells are being produced in the body and how healthy they are. A fall in hemoglobin levels during pregnancy is caused by a greater expansion of plasma volume compared with the increase in red cell volume.

A lack of iron in the diet as a result of not eating enough iron-rich foods or the body’s inability to absorb the iron being consumed. Learn more about how to get iron naturally, Pregnancy itself because the iron being produced is needed for the woman’s body to increase her own blood volume. Without an iron supplement, there is not enough iron to feed the blood supply of the growing fetus. Heavy bleeding due to menstruation, an ulcer or polyp, or blood donation causes red blood cells to be destroyed faster than they can be replenished

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Is 9.7 hemoglobin low in pregnancy?

PHILADELPHIA – Clinicians should not take race into account when diagnosing anemia in pregnant patients and pursuing interventions, according to new research from the Perelman School of Medicine at the University of Pennsylvania, While national guidelines define anemia (low iron levels) differently depending on whether a pregnant patient is Black because lower iron levels are more common among Black women, the researchers found Black patients with no diagnosed anemia during pregnancy were more likely to have anemia at time of delivery compared to non-Black patients.

The results suggest that, in order to intervene early and decrease risk of poor health outcomes and a need for blood transfusions during delivery, Black and non-Black pregnant patients should be treated with the same thresholds when evaluated for anemia. The findings are published in the journal Obstetrics & Gynecology,

“While Black patients may have lower hemoglobin values, there is a consequence to those lower levels, and using a lower hemoglobin ‘cut-off’ level for Black patients is a detriment to optimizing the health of those patients,” said senior author Sindhu Srinivas, MD, MSCE, director of Obstetrical Services at the Hospital of the University of Pennsylvania and a professor of Obstetrics and Gynecology at Penn.

Anemia, a condition caused by insufficient iron levels and consequently insufficient red blood cells, is common in pregnancy, when the body has to supply enough iron to itself and to the developing baby. Anemia during pregnancy can impair the health of the mom and baby, and if persisting during delivery, can require blood transfusions.

The condition can be treated with iron supplements or infusions and is tested by measuring hemoglobin. The American Congress of Obstetricians and Gynecologists (ACOG) defines anemia differently depending on the whether the pregnant person is Black or not, with Black patients requiring lower levels of hemoglobin in order to be considered anemic.

  1. Non-Black patients are considered anemic at hemoglobin levels less than 11 grams per deciliter (g/dL) in the first and third trimesters and less than 10.5 g/dL during the second trimester.
  2. ACOG says Black women should be diagnosed with anemia when they have less than 10.2 g/dL in the first and third trimesters and less than 9.7 g/dL.

After looking at the records of 1,300 patients, self-identified Black patients who had pregnancy hemoglobin levels between 10.2 and 11 g/dL were 65 percent more likely to have hemoglobin levels below 11 g/dL when delivering compared to non-Black patients.

  1. The researchers also saw that both Black and non-Black patients who had less than 11 g/dL hemoglobin at delivery had higher odds of requiring a transfusion.
  2. Penn Medicine is now considering all pregnant patients to be anemic if their hemoglobin levels are below 11 g/dL during any period of pregnancy.

We encourage other obstetricians and clinicians elsewhere to do the same,” Srinivas said. These results come at a time when many healthcare guidelines, especially those that vary depending on race, are being reviewed to address poor maternal and neonatal health outcomes for patients who are Black.

While race and ethnicity has been associated with increased risk of patients developing certain diseases or conditions, it is incumbent upon the medical community to ensure that treatment guidelines are based in actual data, are equitable, and do not contribute to disparities in health,” said lead author Rebecca Feldman Hamm, MD, MSCE, an assistant professor of Obstetrics and Gynecology at Penn.

“We hope our findings will be used in efforts to address guidelines across the country.” Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care.

  • Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $9.9 billion enterprise.
  • The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S.

News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $546 million awarded in the 2021 fiscal year. The University of Pennsylvania Health System’s patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center—which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S.

News & World Report—Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is powered by a talented and dedicated workforce of more than 47,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.
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How much Hb is required for C section?

Emergency cesarean section and blood transfusions in patients with severe anemia-Our experience 1 Department of Anaesthesiology, Government Medical College and Government General Hospital, Anantapur, India 2 Department of Anaesthesiology, Osmania Medical College and Government Maternity Hospital, Hyderabad, Andhra Pradesh, India

Date of Web Publication 26-Nov-2013

Correspondence Address : Kalavala Lakshminarayana Subramanyam # 202, Rajahamsa Rainbow Apartments Aravindnagar 1st Cross, Anantapur – 515 001,Andhra Pradesh India Source of Support: None, Conflict of Interest: None DOI: 10.4103/2277-8632.122161 Introduction: Anemia in pregnancy is a ubiquitous problem, more so in the developing countries. Many of the changes that accompany blood loss appear later, rather than sooner, because obstetric patients are usually young fit adults with an expanded blood volume.

In such cases, the needs for blood transfusions mainly depend on the clinical condition rather than the preoperative value of the hemoglobin (Hb) and blood loss. This is usually due to the tolerance of these chronic anemia patients to the accompanying blood loss. Aim: This study was aimed to see how frequently the patients actually received blood perioperatively.

Material and Methods: This was a retrospective analysis of patients who underwent emergency cesarean sections. A total of 303 patients underwent emergency cesareans with Hb 8 g%. Patients in each group were studied regarding the perioperative blood transfusion, any multiple units received, and complications encountered Results: In Group I, blood transfusion done in 88% cases fell drastically to 30% in Group II and 20% in Group III.

No significant complications were noted and all patients were discharged without any morbidity. Conclusions: The lower cutoff value of Hb level for an emergency surgery remains a big enigma, which needs further evaluation. Clinical judgment in conjunction with the monitoring of tissue oxygen delivery determines the individual patient’s transfusion trigger, and not the use of categorical magic number.

Parturient women tend to have lower hematocrit values due to physiological changes and dilutional effect, but they still can tolerate this chronic anemia without any ill effects. This may be one of the reasons for the reduced need for blood transfusion in our study and also for the successful outcome in spite of severe anemia.

  • Eywords: Anemia, blood transfusion, cesarean section How to cite this article: Subramanyam KL, Murthy M S.
  • Emergency cesarean section and blood transfusions in patients with severe anemia-Our experience.
  • J NTR Univ Health Sci 2013;2:255-60 How to cite this URL: Subramanyam KL, Murthy M S.
  • Emergency cesarean section and blood transfusions in patients with severe anemia-Our experience.
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J NTR Univ Health Sci 2013 ;2:255-60. Available from:


Anemia is perhaps the most common problem in pregnancy in developing countries. Anemia contributes to 10-15% of direct maternal deaths in India. Definition Anemia is defined as a qualitative or quantitative deficiency of hemoglobin or red blood cells in circulation, resulting in a decrease in oxygen carrying capacity of blood to organs and tissues. According to WHO, Hb level of 11 g% is considered anemic during pregnancy. Classification: Mild: 10-10.9 g/dl Moderate: 7-9.9 g/dl Severe: <7 g/dl WHO estimates indicate a 65-75% prevalence of anemia in pregnant women in India. Nearly half of the global maternal deaths due to anemia occur in South Asian countries, 80% of which is contributed by India. In India, Hb level of 10 g% is considered anemic by FOGSI. The heart delivers 2-4 times the amount of oxygen to be consumed at the tissue level. Normal oxygen delivery is approximately 1000 ml/min, and whole-body oxygen consumption is 200-300 ml/min. Oxygen consumption remains constant and is independent of delivery. The critical level of oxygen consumption is approached when Hb concentration decreases to 5 g/dl. Below this value, oxygen consumption becomes dependent on delivery., The changes during pregnancy include the following:

  • Increase in cardiac output, heart rate, and stroke volume
  • Decrease in systemic and pulmonary vascular resistance
  • Dilutional anemia: Disproportionate increase between plasma volume and red cell mass leading to physiological anemia of pregnancy. Plasma volume increases by 40-45%. Red cell mass increases by 15-20%
  • Increase in factors I, VII, VIII, and X (hypercoagulable state)

To summarize, in an anemic pregnant patient, various compensatory mechanisms get activated, as follows:,,,

  1. Increase in cardiac output
  2. Rightward shift of ODC
  3. Decrease in blood viscosity
  4. Increase in 2,3 DPG concentration in RBC
  5. Release of renal erythropoietin, leading to stimulation of erythroid precursors in bone marrow

Thus, although tissue oxygenation is not impaired during physiological or chronic anemia as a result of compensatory mechanisms, these may be compromised in severe or acute onset anemia, leading to serious consequences like right heart failure, angina, and tissue hypoxemia., Clinical experience suggests that Hb levels <7 g/dl is often well-tolerated even in elderly patient. A Hb level of 6 g/dl may be appropriate for normovolemic healthy patient who sustain blood loss and for well compensated chronic patients. Hb transfusion threshold Transfusion threshold is the Hb value, and the Hb value should not fall below it during the perioperative period, particularly in the context of ongoing or anticipated blood loss. ASA task force on blood component therapy (1994) states that "Transfusion is rarely indicated when the Hb conc. is >10 g/dl and almost always indicated when it is <6 g/dl. When Hb conc. is between 6 and 10 g/dl, transfusion based on patient risk for complications of inadequate oxygenation." There is scarcity of data regarding the need of blood transfusions in severely anemic patients posted for emergency LSCS, more so in patients coming from rural background and low socioeconomic status, where prevalence of nutritional anemia is high. We undertook this retrospective analysis to assess the course and outcome of such patients admitted into emergency obstetric ward. The aim of our study was to evaluate the requirement of blood transfusions (if any), complications, and outcome in anemic patients with Hb level <8.5 g/dl posted for emergency cesarean sections in our hospital, where blood bank facilities are restricted.

Materials and Methods

This retrospective study was done in a government hospital that caters primarily to the rural and low socioeconomic population of the district. Most of the patients come to the hospital without proper antenatal work-up and referred to the hospital at odd hours and in emergency situations. This study of 303 patients over a period of 18 months (July 2010 to Dec 2011) with a Hb of <8.5 g/dl were posted for emergency cesarean section. All the patients underwent emergency cesarean section under spinal anesthesia, with oxygen supplementation of 5-6 L/min with a polymask throughout the procedure. Patients pulserate,oxygensaturation, blood pressure, ECG, and urine output were monitored. These patients were divided into three groups: Group I (Hb 8 g%). Of the total 303 patients who underwent emergency LSCS, 26 patients belong to Group I, 171 patients belong to Group II and 106 patients belong to Group III, We evaluated the following:

  • Need for transfusions in each group
  • Multiple blood unit requirement
  • Any intra-operative complications encountered
  • Post-op complications
  • Outcome
  • Influence of other factors viz.
    • Maternal age
    • Primary/repeat section
    • Use of methergin

Finally, the data was compiled systematically and subjected to statistical analysis using Chi-square test. After obtaining the Chi-square values and comparing with the tabular values at 5% LOS ( P = 0.05) the null hypothesis and variables were studied and interpreted for the dependency of stages and groups. P values less than 0.05 was considered significant for all comparisons.



  • Blood transfusion was given in 88% of Group I, 30% of Group II, and 20% of Group III patients,
  • In Group I, the blood transfusion was done in 23 patients (88%), of which 11 patients (42%) received post-op transfusions only, 6 patients received both pre-op and post-op transfusions, and 2 patients received both intra-op and post-op transfusions,
  • In Group II patients, the number of transfusions came down significantly to 30% (51 out of 171).
  • Of the 51 patients who received transfusions, 44 patients (86%) received in the postoperative period. Multiple transfusions were given in one patient,
  • In Group III, which consisted of 106 patients, only 20 patients (19%) received post-op transfusion and 1 patient pre-op. No one received multiple transfusions,
  • Figure 3: Bar diagram showing frequency of blood transfusions perioperatively in Group I (Hb <7 g%) Click here to view


    Figure 4: Bar diagram showing frequency of blood transfusions perioperatively in Group II (Hb 7-8 g) Click here to view


    Figure 5: Bar diagram showing frequency of blood transfusions perioperatively in Group III (Hb >8 g%) Click here to view


    • In Group I, 1 patient had burst abdomen and required secondary suturing and 1 patient complained of breathlessness.
    • In Group II, 4 patients complained of breathlessness and 1 patient had pedal edema.
    • In Group III, 2 patients complained of breathlessness and 1 patient complained of abdominal distension
    • Other minor problems include vomiting (2 patients) and cough (3 patients).
    • Three patients of PIH had convulsions post-operatively, treated conservatively.

    All these patients were managed conservatively

    • There were no maternal deaths in any group.
    • All the patients were discharged without any morbidity.
    • Only 1 patient in Group II who had a Hb% of 7.6 g/dl had a fall of Hb% to 4.8 and, in spite of two transfusions, the Hb% did not improve (4 g/dl). The patient absconded in spite of the advice of hospital stay and need for further blood transfusions.

    No statistical significance (Chi-Square values obtained less than the tabular values) found between maternal age (5.4375,

    Table 1: Table Depicting Influence of Blood Transfusions on Maternal Age, Primary/Repeat Section, Use of Methergin) Click here to view



    The anesthetic implications of anemia in pregnancy are based on the understanding of the normal and compensatory mechanisms that optimize tissue oxygenation. The main aim was to maintain a fine balance between the compensatory mechanisms and adequate tissue oxygenation in these parturient. Monitoring should aim at assessing the adequacy of perfusion and oxygenation and the magnitude of ongoing losses. Deleterious effects of chronic tissue hypoxemia along with threat of major blood losses in the perioperative period need to be anticipated and treated adequately. Chronic anemia is better tolerated than acute anemia. In chronic anemia, cardiac output usually does not change until Hb concentration falls below 7 g/dl Obstetric patients usually tolerate chronic anemia without significant maternal or fetal effects. For years, anesthesiologists have believed a minimum Hb of 10 g/dl for a safe conduct of anesthesia. A better understanding of and better means of monitoring the relationship between oxygen delivery and oxygen consumption will eventually lead to a more precise delineation of the appropriate transfusion trigger. No single index can be the basis of perioperative transfusion. Clinical judgment in conjunction with the monitoring of tissue oxygen delivery will determine the individual patient’s transfusion trigger and not use categorical magic number. FDA drug bulletin 1989 states that “adequate oxygen carrying capacity can be met by a Hb of 7 g/dl or even less, when intravascular volume is adequate for perfusion.” The concept of an acceptable Hb level varies with the underlying medical condition, extent of physiological compensation, the threat of bleeding, and ongoing blood losses. The main anesthetic considerations are to minimize factors interfering with oxygen delivery, prevent any increase in oxygen consumption, and optimize the partial pressure of oxygen in the arterial blood. Monitoring should focus mainly on the adequacy of perfusion and oxygenation of vital organs. Hypoxia, hyperventilation, hypothermia, acidosis, and other conditions that shift the ODC to left should be avoided. Any decrease in cardiac output should be averted and aggressively treated. Most of the rural Indian women has moderate to severe anemia without any clinical signs and symptoms. These women after becoming pregnant tend to still have lower hematocrit values due to physiological changes and dilutional effect, but then, they can tolerate this chronic anemia without any ill effects. This may be one of the reasons for the reduced need for blood transfusion in our study and also for the successful outcome despite severe anemia. The decision to transfuse blood should be taken on clinical and hematological grounds. Transfusion is rarely indicated in a stable patient when Hb level is >10 g and is almost always indicated when Hb is <6 g., In our study, we found that there was a significant increase in the blood transfusions in Group I. If the Hb is 7-8 g in labor or in the post-partum period, the decision to transfuse should be made on an informed basis according to symptoms, coexisting medical condition, continuing blood loss, and threat of bleeding. There is little evidence of benefit of blood transfusion in asymptomatic parturient.,, Our study showed the same as there was significant reduction in blood transfusions in Group II and Group III. The general policy of our hospital was to wait and watch in parturients with Hb of 8 g/dl. Benefits from replenishing oxygen carrying capacity by transfusion must always be balanced against transfusion-associated risks like pulmonary oedema and immune suppression., In a large randomized controlled trial (RCT), Hebert established that there was no difference in mortality rates between restrictive and liberal transfusion strategies in non-cardiac and critically ill patients who were able to tolerate lower levels of Hb., Reiles and Linden indicated in a study that the maintenance of a higher Hb concentration with RBC transfusion in an attempt to increase tissue oxygen delivery is not associated with clinical benefit, as transfusion-related increased blood viscosity can result in a reduction in blood flow and incipient cardiac failure. Also, the storage process affects the ability of RBCs to transport and deliver oxygen to the tissues, due to decreases in erythrocyte concentrations of 2, 3-DPG to 1 mol/g of Hb or less at 21 days of storage. This point, however, remains controversial. After considering the various clinical data, we may conclude that low Hb level alone is not a trigger to initiate transfusion. Various physiological aspects like cardiovascular fitness, age, operative blood loss, and disease status of the parturient are important than mere relying on a single value of hemoglobin. Decision should be taken only after considering the potential clinical benefits, adverse effects, and cost of blood component therapy. Spencer studied patients undergoing elective joint replacement surgery and found that enforcement of local transfusion algorithms reduced overall transfusion rates by half, with no adverse outcomes, and with sustained effect. Similarly, Mallett found a 43% decrease in transfusions following the implementation of transfusion guidelines after an initial audit. It was appropriately pointed by Weiskopf (1998) as we merely awaited an advance in technology that will enable us to measure directly the value of concern and thereby free us from arguments over which surrogates (e.g., Hb) to measure and what value indicates the need for augmented oxygen delivery. A "minimum acceptable hemoglobin level" does not exist. A healthy myocardium compensates for the low Hb or Hct levels (7-8 g/dL of Hb or 21-24% Hct) in order to optimize oxygen delivery. In patients with overt or silent episodes of myocardial ischemia (diabetic parturient), a level of <10 g/dL carries risk of decompensation., Our study had some limitations. We estimated Hb% alone and not other blood indices or complete hemogram (hemoglobin value alone may not truly reflect the correct status of the patient). Also, intraoperative bedside estimation of Hb was not performed. Moreover, we used whole blood transfusion rather than packed cells/blood component therapy. Anesthesiologist faces 1) a worried mother, 2) her critically ill fetus, and 3) an anxious obstetrician. It is not ethical to defer an emergency cesarean section, just for anemia. Perioperative management of patients with low Hb values, posted for emergency cesarean sections can be safe and effective, provided proper clinical judgment of the patient, clinical lab facility, intraoperative management, post-operative care, and back-up blood bank facilities are good. In India, cesarean section is the most common emergency surgery that is required to be done at the district and taluq hospitals, both government and private, and severe anemia is the most common problem encountered with little assistance of blood bank facilities. The anaesthesiologist should be able to assess the condition of the patient and should not hesitate to undertake cesarean section rather than referring the patient, thereby delaying the operation and risking the lives of both the mother and child. Despite a plethora of manuscripts in the current literature of anemia in pregnancy, comprehensive evidence is still lacking regarding the cut-off Hb value for emergency cesarean sections, probably due to heterogeneity of clinical studies, various study designs, and sample sizes. Hence, further clinical studies in this regard are mandatory in higher centers. Be more optimistic, as you are dealing with TWO LIVES!

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    1. Gopalan S, Jain V. Anemia in Pregnancy. Mudaliar and Menon′s Clinical Obstetrics.10 th ed. Chennai: Orient Longman; 2005.p.147-50. 2. Kalaivani K. Prevalence and consequences of anaemia in pregnancy. Indian J Med Res 2009;130:627-33. 3. DeMaeyer E, Adiels-Tegman M. Prevalence of anemia in the world. World Health Stat Q 1985;38:302-16. 4. Hoeft A, Weitasch JK, Sonntag H, Kettler D. Theoretical limits of permissive anaemia′ Zentralbl Chir 1995;120:604-13. 5. Ostgaard G. Perioperative and Postoperative normovolemic anaemia: Physiological compensation, monitoring and risk evaluation. Tidsskr Nor Laegeforen 1996;116:57-60. 6. Birnbach DJ, Browne IM. Anaesthesia for obstetrics. RD, editor. Miller′s Anaesthesia.7 th ed. Philadelphia: Churchill Livingstone; 2010.p.2204-5. 7. Basu SM. Anaemia and Pregnancy. In: Gupta S, editor. Obstetric Anaesthesia.1 st ed. Delhi: Arya Publications; 2004.p.433-56. 8. Rutter TW, Tremper KK. The physiology of oxygen transport and red cell transfusion. In: Healy TE, Knight PR, editors. Wylie and Churchill-Davidson′s A Practice of Anesthesia.7 th ed. London: Arnold; 2003.p.167-83. 9. Bailey K, Gwinnutt C. The physiology of red blood cells and haemoglobin variants. Available from:, 10. Sharma SK. Hematologic and coagulation disorders. In: Chestnut DH, Polley LS, Tsen LC, Wong CA, editors. Chestnut′s Obstetric Anesthesia. Principles and Practice.4 th ed. USA: Mosby Elsevier; 2009.p.943-7. 11. Rinder CS. Hematologic disorders. In: Paul AK, Hines RL, Marschall KE, editors. Stoelting′s Anesthesia and Co-existing Diseases.5 th ed. India: Elsevier; 2010.p.448-56. 12. Practical guidelines for blood component therapy: A report by the Americal Society of Anesthesiologists Task Force on Blood Component Therapy. Anaesthesiology 1996;84:737-47. 13. Czer LS, Shoemaker WC. Optional haematocrit value in critically ill postoperative patients. Surg Gynaecol Obstet 1978;147:363-8. 14. Spahn DR, Leone BJ, Reves JG, Pasch T. Cardiovascular and coronary physiology of acute isovolemic hemodilution: A review of non-oxygen carrying and carrying solutions. Anaesth Analg 1999;78:1000-21. 15. Grewal A. Anaemia and pregnancy: Anaesthetic implications. Indian J Anaesth 2010;54:380-6. 16. Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, et al, British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001;113:24-31. 17. Blood Transfusions in Obstetrics. RCOG Green-top Guideline. No.47. December 2007. Avialable from, 18. Practice guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology 1996;84:732-47. 19. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006;105:198-208. 20. Kubanek B. The critical hemoglobin value in the therapy of chronic anemia. Beitr Infusionsther 1992;30:224-7. 21. Alvarez G, Hébert PC, Szick S. Debate: Transfusing to normal hemoglobin levels will not improve outcome. Crit Care 2001;5:56-63. 22. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al, A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340:409-17. 23. Reiles E, Van der Linden P. Transfusion trigger in critically ill patients: Has the puzzle been completed? Crit Care 2007;11:142. 24. Valeri CR, Valeri DA, Gray A, Melaragno A, Dennis RC, Emerson CP. Viability and function of red blood cell concentrates stored at 4 degrees C for 35 days in CPDA-1, CPDA-2, or CPDA-3. Transfusion 1982;22:210-6. 25. Weiskopf RB, Feiner J, Hopf H, Lieberman J, Finlay HE, Quah C, et al, Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology 2006;104:911-20. 26. Spencer J, Thomas SR, Yardy G, Mukundan C, Barrington R. Are we overusing blood transfusing after elective joint replacement? A simple method to reduce the use of a scarce resource. Ann R Coll Surg Engl 2005;87:28-30. 27. Mallett SV, Peachey TD, Sanehi O, Hazlehurst G, Mehta A. Reducing red blood cell transfusion in elective surgical patients:The role of audit and practice guidelines. Anaesthesia 2000; 55:1013-9. 28. Weiskopf RB, Vieleo MK, Feiner J, Kelley S, Lieberman J, Noorani M, et al, Human cardiovascular and metabolic response to acute, severe anemia. JAMA 1998;279:217-21. 29. Lundsgaard-Hansen P, Doran JE, Blauhut B. Is there a generally valid, minimum acceptable hemoglobin level? Infusionstherapie 1989;16:167-75.

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    Is 9.6 hemoglobin low in pregnancy?

    What do you need to know about anemia during pregnancy? – The wonder and joy of pregnancy is matched by the body’s ability to adapt to looking after the growing baby. In addition to the mother’s physiologic needs, there is the additional need to provide the building blocks to optimally grow baby.

    • All this construction requires energy and oxygen as the fuel that helps drive the engine.
    • Oxygen in the air that we breathe is delivered to the cells of the body by hemoglobin, a protein molecule found in red blood cells,
    • The normal ranges for hemoglobin depend on the age and, beginning in adolescence, the gender of the person.

    For example, the normal ranges of hemoglobins for background comparison are:

    Newborns: 17 to 22 gm/dl Babies 1 week of age: 15 to 20 gm/dl Babies 1 month of age: 11 to 15 gm/dl Children: 11 to 13 gm/dl Adult men: 14 to 18 gm/dl Adult women: 12 to 16 gm/dl Men after middle age: 12.4 to 14.9 gm/dl Women after middle age: 11.7 to 13.8 gm/dl

    Anemia is a decrease in the amount of hemoglobin and red blood cells. Anemia is a relatively normal finding in pregnancy. Plasma is the watery, noncellular component of blood. In pregnancy, there is an increase in plasma volume of the blood in order to help supply oxygen and nutrients to mother and baby.
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    Can bananas raise your hemoglobin?

    Abstract The purpose of this study is to determine whether there are differences in hemoglobin levels before and after consuming ambon bananas in students of Prodi Kebidanan Metro. The specific purpose of this study was to determine hemoglobin levels before consuming ambon bananas, hemoglobin levels after consuming ambon bananas and the differences in hemoglobin levels before and after consuming ambon bananas in female students at Prodi Kebidanan Metro.

    This research is an intervention research with quasi experiment design with The One Group Pretest – posttest design. The population in this study were students in the first and second grade in Prodi Kebidanan Metro who lived in the dormitory as many as 149 female students. A sample of 49 people will take a portion of the population using simple random sampling technique.

    Data analysis used dependent sample t tests to test the mean increase in Hb levels before and after consuming ambon bananas. The results showed an average Hb level before consuming bananas at 12.51 g/dl and an the average hb level after consuming bananas was 12.89 g/dl, so the average increase in Hb levels was 0.39 g/dl.

    The results of the analysis using the t -test dependent test obtained p value = 0.000, which means that there are significant differences in Hb levels of students before and after consuming ambon banana. Keywords: Hemoglobin Ambon bananas Student Texto completo Introduction Based on the results of the 2004 World Health Organization 1 survey, the estimated incidence of anemia in the whole world is around two billion.

    Iron deficiency is the main cause of anemia in the world at 50–80%. MOH Report the prevalence of anemia among Indonesian teenagers (aged 15–19 years) 26.5%, and women of childbearing age (26.9%. Based on the age grouping of the 2013 Riskesdas, 2 it was found that anemia in adolescents was quite high at 18.1%, Anemia in women is 23.9%.

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    The anemia cut-off point for women of childbearing age 15–49 years is Hemoglobin (Hb) levels below 12.0 g/dl. This indicates that anemia in adolescent females is still high despite a decline (Ministry of Health, 2013). The prevalence of female adolescent anemia in Metro City is 2 groups: 10–14 years age group of 49% and 15–19 years age group of 67% (Metro City Health Office, 2016).

    Adolescent nutrition problems need special attention because of their great influence on the growth and development of the body and its impact on nutritional problems as adults. At present the population of adolescents in the world has reached 1200 million.

    1. Teenage is a transition period for children and adults.
    2. During adolescence hormonal changes accelerate growth.
    3. Growth is faster than other phases in life, except the phase of the first year of life (baby).3 The results of various anemia surveys in several regions in Indonesia indicate that the incidence of anemia in young women in Indonesia is still quite high.

    The survey at SMAN 2 Semarang found that the prevalence of anemia among young women was 36.7%.4 Another survey in Bekasi of junior and senior high school students aged 10–18 years showed an anemia prevalence of 38.3%.5 Research on young women at SMAN 1 Brebes showed anemic prevalence of 52.9%.6 The prevalence of anemia in adolescents from 2001 in Lampung Province is recorded as the third stage after West Sumatera and North Sumatera is 25.9% (Ministry of Health and Development of Depkes RI, 2008), 7 and in 2010 found the results of the incidence of anemia 25.9% in Adult women (≥15 years).

    The prevalence of juvenile anemia in Kibang based on Sukmawati research in 2011 was obtained 65% from 142 Junior high school students Kibang suffering from anemia (Sukmawati, 2011:48).8 Research at MAN 1 Metro 2014 found that there were 40% of young women experiencing anemia.9 One type of food that contains iron is a banana with an iron content of 0.5 mg per 100, in addition to its relatively inexpensive price, the taste is sweet and easy to get it and its texture that makes it easy to consume it, if Compared to other vegetable types, mineral bananas, especially iron can almost completely absorbed by the body.

    In addition to the content of banana iron contains vitamin C which is high enough to facilitate the absorption of iron in the body.10 Based on a preliminary survey conducted by researchers at the college student Prodi Kebidanan Metro as much as 10 people obtained the highest Hemoglobin (Hb) level is 14 mg/dl and the lowest Hb level is 10.3 mg/dl.

    The level of Hb below normal as much as 60%. These results show that there are still many teenagers in this college student Prodi Kebidanan Metro which has a Hemoglobin level below the normal limit. Research methods This research is a type of quantitative study with the design of a quasi experiment with The One Group Pretest – posttest.

    The population of this study were Level I and II Metro Midwifery Study Program students who lived in dormitories of 149 female students. The sample is 49 people, the sampling technique is Simple Random Sampling. The study was conducted at Prodi Kebidanan Metro in July to November 2016.

    In this study the researchers used two variables, namely the dependent variable is Hemoglobin level, the independent variable is consumption of ambon banana by eliminating several other variables that are closely related to increased hemoglobin levels by controlling or reducing consumption of other foods that contain lots of iron (Fe) such as meat.

    Data collection using hemoglobin measurements before and after the intervention of administration of ambon banana. Research step implementation : (1) Researchers gather all the sorority that will be the subject of research. (2) Explain to respondents/sorority the course of research, benefits as well as impact of research.

    3) Uniformity of respondents with BMI measurement, further measuring the initial hemoglobin level before the administration of banana ambon and making an introduction to the research consent. (4) In the measurement of hemoglobin, which is selected to be the sample is the level of hemoglobin under 13 mg/dl.

    After the measurement of hemoglobin is done routinely grant intervention of banana ambon to respondents every day as much as 100 g of banana ambon (about 2 medium banana fruit) for 30 days (1 month). The awarding was done before breakfast and before the lunch coordinated through the dorm kitchen.

    1. Assisted by enumerators as well as monitoring banana consumption daily and monitoring other food consumption every 2 days by the enumerator.
    2. One enumerator controlled 9–10 respondents.
    3. 5) Giving banana ambon regularly every day for 30 days at 0.5 h before breakfast and before lunch.
    4. 6) If the student stays outside the dormitory then the student is presented with as many bananas how long he is not in the dorm and students are required to stay abreast of the research rules by avoiding foods containing high Fe levels.

    (7) Measuring hemoglobin back after 30 days of banana administration. (8) Data of research results are emulated and conducted analysis. Result and discussion Based on the results of studies that have been conducted against 49 students Prodi Kebidanan Metro then obtained data as listed in following Tables 1 and 2,

    Of the 49 respondents measured by of the 49 respondents measured by hemoglobin before consuming ambon banana with the lowest hemoglobin level was 10.4 g/dl and the highest hemoglobin level was 13.7 g/dl and the mean hemoglobin level of the respondents was 12.5 g/dl. After consuming ambon bananas the lowest hemoglobin level 10.4 g/dl, the highest was 14.8 g/dl with an average of 12.9 g/dl.

    The average increase in hemoglobin levels before and after consuming ambon banana was 0.3857 g/dl. There were differences in hemoglobin levels before and after consuming ambon banana on Prodi Kebidanan Metro students of 0.39 g/dl with p value = 0.000 which means there were significant differences in the hemoglobin level of student before and after consuming ambon banana.

    1. The results of this research in accordance with the statement Sentana (2013) 10 stating that the banana fruit contains a relatively high iron so that the fruit is able to help the function of hemoglobin in the body.
    2. For anemia sufferers are advised to consume banana fruit on a regular basis, it is very good to restore blood pressure in the body and help to stabilize hemoglobin.

    Another statement mentioning the benefits of iron or Fe in banana ambon which is high enough to help cope with the disorder of anemia, namely by the way of increasing red blood cells in the body. Iron contained in bananas, almost 100% can be absorbed by the body.11 In addition to iron, the banana fruit contains vitamin B6 which plays a role in the neurotransmitter that turns out to be able to increase the growth of hemoglobin in the body.12 Based on research in India stating that the banana fruit contains high levels of iron, the banana fruit can stimulate the production of hemoglobin in the blood and help overcome anemia.

    Bananas are also a good source of Vitamin C in immune system. Bananas are also relatively digestible compared to other foods. Both of these banana health benefits make it suitable for people with anemia or related blood problems.13 Putra (2014) 14 and Kumar (2012) 13 mention clinically, the benefits of banana fruit ambon or commonly called green bananas are very diverse one of which is overcoming anemia.

    Banana fruit has a high enough iron content that is suitable for people with anemia. Consume 2 bananas (±100 g). Every day routinely can overcome the deficiency of red blood cells or anemia. Researchers assumed differences in Hemoblobin levels before and after consuming banana ambon, because banana ambon contains many energy including: carbohydrates, proteins, fats, vitamins, and minerals, especially iron.

    • Iron Works to increase Hemoglobin level.
    • This is in accordance with the theory that the iron contained in banana ambon is quite high and consume it can help increase the level of hemoglobin in the blood.
    • Why banana ambon is given because banana ambon contains complete nutrients, especially minerals and vitamins, and contains iron 0.5 mg in each of 100 g of bananas.

    Moreover, banana ambon is relatively inexpensive and easy to get it both in the traditional market as well as in the modern market. Thus, banana ambon is very good at raising the level of Hemoglobin or preventing anemia. However, it is undeniable that the iron content remains higher on foods containing animal proteins.

    1. Preferably in the provision of daily food menu still available animal proteins that contain iron, coupled with the gift of fruit ambon banana to increase and facilitate the absorption of iron that can later serve to increase the level of hemoglobin.
    2. Furthermore, for food managers for students who reside in the dormitory the fruit menu to be given more often banana ambon.

    Students who are domiciled outside the hostel so that they can add fruit in the daily menu, especially banana ambon. This is because in addition to the cheap price, it feels good, the nutrient content is very complete include: carbohydrates, proteins, fats, vitamins and minerals, especially iron.

    1. It is not less important that banana ambon is a fruit that is easily obtained both in the traditional market and in the modern market.
    2. Conclusion The results showed an average Hb level before consuming bananas at 12.51 g/dl and an the average hb level after consuming bananas was 12.89 g/dl, so the average increase in Hb levels was 0.39 g/dl.

    The results of the analysis using the t -test dependent test obtained p value = 0.000 which means that there are significant differences in Hb levels of students before and after consuming ambon banana. Funding This research have been funded by Poltekkes Tanjungkarang.

    Conflict of interest The authors declare no conflict of interest. References WHO. Worldwide prevalence of anaemia 1993–2005. Ministry of Health Republic of Indonesia (2013). Basic health research (RISKESDAS). Lembaga Penerbitan Litbangkes, (2013), A. Soliman, V. De Sanctis, R. Elalaily, S. Bedair. Advances in pubertal growth and factors influencing it: can we increase pubertal growth?.

    Indian J Endocrinol Metab, 18 (2014), pp.53-62 P.F. Purwaningtyas. Analisis Pengaruh Mekanisme Good Corporate Governance Terhadap Nilai Perusahaan. Skripsi Jurusan Akuntansi Fakultas Ekonomi Universitas Diponegoro, (2011), D. Briawan, T. Herta. Kebiasaan makan dan aktivitas fisik remaja obes: studi kasus pada murid SMU Kornita Bogor.

    PGM, 34 (2011), pp.138-146 D. Gunatmaningsih. Faktor-faktor yang Berhubungan dengan Kejadian Anemia pada Remaja Putri di SMA Negeri 1 Kecamatan Jatibarang Kabupaten Brebes Tahun. Skripsi. Universitas Negeri Semarang, (2007), R.I. Depkes. Daftar Komposisi Bahan Makanan. Brathara Karya Aksara, (1981), Sukmawati.

    Faktor-faktor yang Berhubungan dengan Kejadian Anemia pada Remaja Putri Kelas VII dan VIII di SMP Metro Kibang Lampung Tiur Tahun. KTI. Tidak Dipublikasikan, (2011), Martini. Faktor – faktor yang Berhubungan dengan Kejadian Anemia pada Remaja Putri Kelas XI di MAN 1 Metro Lampung Timur.

    Metro. Sentana. Khasiat dan Manfaat Buah Pisang.N. Kurnianti. Kandungan dan Manfaat Pisang Bagi Kehidupan.Y. Yulia.20 Manfaat Pisang untuk Ibu Hamil.K.P.S. Kumar, D. Bhowmik, S. Duraivel, M. Umadevi. Traditional and medicinal uses of banana. J Pharmacogn Phytochem, 1 (2012), A. Putra. Kandungan Gizi Nutrisi Pisang Ambon & Manfaatnya.

    Peer-review under responsibility of the scientific committee of the 3rd International Conference on Healthcare and Allied Sciences (2019). Full-text and the content of it is under responsibility of authors of the article.
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