Coming to the end of the course

This week I will be submitting the final two assignments for the course.  Once the results have been finalised I will be able to apply for a prescriber number.  Here's the process (I like to record the links here so that I can refer back to it when I need to, or if anyone asks me about the course):

Applications forms are available from the AHPRA website:

http://www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/Endorsements-Notations.aspx.

Once I have been endorsed with APHRA as a midwife able to prescribe scheduled medicines, I need to apply for a prescriber number. Information regarding this process, application forms and order forms for prescription pads with my name on them are available from the Medicare Australia website: http://www.medicareaustralia.gov.au/provider/other-healthcare/nurse-midwives.jsp.

Once I have a prescriber number I can register to receive the Australian Prescriber journal, which is free to all Australian prescribers. Details are available from their website: www.australianprescriber.com.

 
One of the areas of  'extension' to my knowledge that I have experienced in completing this course is a better understanding of the relatively simple and routine investigations that are done for healthy women in their pregnancies.  For example, blood tests that detect anaemia, (FBE and Iron studies), and understanding when anaemia is best treated with iron supplements. 

The wonderful web has given me access to good sites that I might not have accessed otherwise.  For example, from the UK GP Notebook site:

The mean minimum value for haemoglobin accepted by the World Health Organisation is 11.0 g/dl (at sea level). A woman with haemoglobin levels below this value that occur during pregnancy has, by definition, anaemia in pregnancy.

Anaemia in pregnancy is more common in patients who are already anaemic at conception e.g. patients with haemoglobinopathies, poor diet, with a history of menorrhagia. Women with a multiple pregnancy are more prone to the development of anaemia.

During the antenatal period Hb estimation are routinely taken at booking, 28, 32 and 36 weeks. An iron deficiency anaemia will exhibit a low serum iron and raised total iron binding capacity, with a hypochromic microcytic film and low serum ferritin.

(GP Notebook: Anaemia in pregnancy http://www.gpnotebook.co.uk/simplepage.cfm?ID=1516961871 )

Comments on ferritin, from Melbourne Haematology

Small amount of circulating serum ferritin reflects body iron stores.  Is now well established in assessment of iron stores

Normal range 15 – 300 ug/l  (reference ranges vary depending on the method used)

Levels < 15 ug/l reflect absent / reduced iron stores 

Elevated levels may reflect iron overload but will be increased in liver disease, inflammation or malignant disease. In the presence of inflammation, a level of > 100 ug/l generally excludes iron deficiency (Melbourne Haematology http://www.melbournehaematology.com.au/pdfs/guidelines/melbourne-haematology-guidelines-iron-studies.pdf

Note on Haemoglobin: NICE (2008) advises that Hb below 11g/dL in early pregnancy (at first contact) and 10.5 g/dl at 28 weeks should be investigated and Fe supplementation considered.

The fall in Hb during pregnancy, indicating a healthy plasma volume expansion, does not indicate the need for Fe supplementation. (Little et al 2005)

There is a considerable variation in the Reference values for low (100-115) and high (137-165)



From the South Australia Health Department's site

Anaemia with a low MCV that does not respond to iron supplementation should be investigated with iron studies. True iron deficiency is characterised by the following taking all parameters into account:

>  Low ferritin (< 15 mg / L) 

>  High transferrin (> 5.56 mmol / L) concentration (transferrin levels are higher in than outside pregnancy)

>  Low serum iron (< 8 mmol / L) 

>  Low transferrin saturation (< 10 %)

SA Health Dept, Maternity Care in SA: Anaemia in pregnancy (http://www.health.sa.gov.au/PPG/Default.aspx?PageContentID=2479&tabid=95 )
Thankyou for your comments