Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. The causes of anemia are broadly attributed to nutritional deficiencies, infections (malaria, HIV and hookworm infestation) and genetic disorders, particularly the hemoglobinopathies, beta thalassemia and sickle cell anemia.Globally, iron deficiency accounts for the highest cause of anemia (63%), followed by thalassemia trait (5.4%), malaria (4%) and sickle cell trait (2.2%). India has a dual burden of nutritional anemia and haemoglobinopathies.

Although anemia is highly prevalent in our country, the schematic evaluation, investigation and typing of anemia is not routinely practiced.  The pregnant women are covered with iron supplements still the prevalence of anemia is higher. This warrants the need for identification of the other underlying nutritional deficiencies, prevalent inherited or acquired causes of anemia.

The pregnant women diagnosed with severe anemia presenting to antenatal OPD or ward in JIPMER fulfilling the inclusion criteria and willing to participate will be enrolled in the study.  Detailed history will be noted down in pre-designed clinical proforma including personal details, sociodemographic details, menstrual, obstetric history, relevant past and family history, dietary history, intake of oral iron, folate, multivitamins, medical comorbidities, treatment details of severe anemia in JIPMER or outside i.e., parenteral iron supplementation and blood transfusions. General examination including vitals, pallor, edema, Jugular venous pressure (JVP) assessment will be done with cardiovascular and obstetric examination.

 10 ml (5ml for biochemistry tests +CBC with peripheral smear and 5 ml for HPLC) blood sample will be taken at first point of contact with the patient in the WCH OPD/ Casualty/labor room  and submitted at Biochemistry (TIBC, Transferrin saturation, serum ferritin, serum folate, serum vitaminB12) & Pathology laboratory of JIPMER (CBC with peripheral smear and HPLC for hemoglobin variants in blood picture showing microcytic and dimorphic anemia if indicated based on the CBC and peripheral smear findings) for analysis. Diagnosis will be made based on clinical and laboratory details. Further work-up if indicated and treatment will be instituted as per the existing departmental protocols.