Anemia During Pregnancy

Anemia is a word for a lower than normal level of red blood cells (RBC), cells containing hemoglobin (Hb) which carries oxygen from lungs to tissues. Iron is a component of Hb. Deficiency of iron results in fewer and smaller RBC containing less Hb, resulting in impaired delivery of vital oxygen to all the tissues. There are other deficiencies which also cause lower Hb or fewer RBC. Sometimes the number of RBC increase, such as the normal compensation seen at high altitudes. Most normal people have a blood Hb level of 12 - 14. During pregnancy the NORMAL level goes down as low as 9.5. The longer the pregnancy, the lower the normal value. Hemoglobin, containing iron, is heavy, so when blood is spun in a centrifuge, the RBC drop to the bottom. The column of RBC as a % of total blood volume is the hematocrit (hct). Most normal people have hct 36-42. During pregnancy the NORMAL hct goes as low as 28. The older the pregnancy the lower the hct. There are MANY possible causes for low Hb or low hct, pregnancy being one of them. In order to determine iron stores in the blood we need to measure iron. Usually this includes serum iron and ferritin. This is quite apart from Hb and hct. It is useful to supplement a pregnant woman if her ferritin is less than 20. If the woman is not deficient in iron, then iron supplements are not needed and can be harmful, even if Hb & hct are low. If ferritin is very high, she must be studied for possible iron overload (hemochromatosis) which causes diabetes and liver disease. Low Hb & hct may occur because of blood loss, various genetic abnormalities, bone marrow disease, destruction of RBC (hemolysis), chronic disease, or senility to mention some broad categories. While many women benefit from a small, slow-release iron supplement while pregnant, it is prudent to check their iron levels first. Treatment on the basis of Hb or hct alone will often be misdirected.

Iron, Anemia, and Spinach

Spinach contains large amounts of oxalic acid. This binds to iron and calcium to form oxalates.  Iron is abundant in spinach because of the great affinity of iron and oxalic acid for each other, resulting in iron oxalate.  If you burn spinach and analyze the ash you find iron.  Eighty years ago a laboratory analysis of spinach revealed a surprisingly high iron content.  Eager spinach farmers hired a promoter to sell their product.  So POPEYE was born.  He ate spinach (iron) and became a strong man.  Only, here's the rest of the story.  Oxalates do not dissolve in water.  They make stones in urine. THEY ARE POORLY ABSORBED FROM FOOD.  Furthermore since the oxalic acid is not saturated, it can grab the iron from other foods eaten at the same time.  Although spinach is otherwise an excellent food, the iron and calcium in it are poor sources of these nutrients. Eating more spinach is not a remedy for iron deficiency.  The iron is passed out, not absorbed.  Calcium in spinach is 8% absorbed, compared, for example to 50% absorption from broccoli.