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[15]                                                                                                                                                                                                                                              AJDHS.COM 

 

 

Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2025 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the 

original author and source are credited  

 

 

Mentzer Index in High-Risk Pregnancies: Anemia Screening and Management 

Emmanuel Ifeanyi Obeagu *  

Department of Biomedical and Laboratory Science, Africa University, Zimbabwe 

Article Info: 
_____________________________________________ 
Article History: 

Received   05 Nov 2024     
Reviewed  16 Dec 2024 
Accepted   12 Jan 2025 
Published 15 March 2025 

_____________________________________________ 
Cite this article as:  

Obeagu EI, Mentzer Index in High-Risk 
Pregnancies: Anemia Screening and 
Management, Asian Journal of Dental and Health 
Sciences. 2025; 5(1):15-19                                                                    

DOI: http://dx.doi.org/10.22270/ajdhs.v5i1.113           

Abstract 
_________________________________________________________________________________________________________________ 

Anemia remains a common and critical health issue in high-risk pregnancies, leading to adverse 
outcomes for both the mother and fetus, including preterm birth, low birth weight, and maternal 
fatigue. Differentiating between the two most common causes of microcytic anemia—iron deficiency 
anemia (IDA) and thalassemia trait (TT)—is essential for appropriate management. The Mentzer 
Index, calculated by dividing the mean corpuscular volume (MCV) by the red blood cell (RBC) count, 
has been proposed as a simple and effective tool to distinguish between these two conditions. This 
review explores the role of the Mentzer Index in anemia screening and management, particularly in 
high-risk pregnancies, where timely and accurate diagnosis is crucial for improving health outcomes. 
The application of the Mentzer Index in high-risk pregnancies offers a quick and cost-effective 
method for clinicians to identify whether the anemia is likely due to IDA or TT. A Mentzer Index 
score below 13 typically suggests thalassemia trait, while scores above 13 generally point toward 
iron deficiency anemia. While useful, the Mentzer Index is not definitive on its own and should be 
complemented by other diagnostic tests, such as hemoglobin electrophoresis, serum ferritin, and 
transferrin saturation, to confirm the underlying cause of anemia. By integrating these methods, 
healthcare providers can better tailor treatment plans, ensuring that women with IDA receive 
appropriate iron supplementation while avoiding iron overload in those with thalassemia trait. 

Keywords: Mentzer Index, high-risk pregnancies, anemia screening, iron deficiency anemia, 
thalassemia trait 

*Address for Correspondence:   

Emmanuel Ifeanyi Obeagu, Department of Biomedical and Laboratory Science, Africa University, Zimbabwe 

 

Introduction 

Anemia is one of the most prevalent conditions affecting 
pregnant women globally, with particularly high rates 
observed in high-risk pregnancies. High-risk 
pregnancies encompass those involving women with 
preexisting health conditions such as diabetes, 
hypertension, or nutritional deficiencies, as well as 
those carrying multiple fetuses or facing socioeconomic 
challenges. These women are more vulnerable to 
anemia due to the increased nutritional demands during 
pregnancy and the complexities associated with 
managing existing health conditions. Anemia in 
pregnancy, if left untreated, can lead to a range of 
maternal and fetal complications, including preterm 
birth, low birth weight, and maternal fatigue. As a result, 
proper diagnosis and management of anemia are vital 
for ensuring the health and well-being of both the 
mother and the developing fetus.1-2 Two of the most 
common causes of microcytic anemia during pregnancy 
are iron deficiency anemia (IDA) and thalassemia trait 
(TT), both of which present with similar clinical 
features, such as low hemoglobin levels and microcytic 
hypochromic red blood cells. However, these two types 
of anemia require distinctly different treatment 
approaches. IDA is typically treated with iron 

supplementation, while thalassemia trait is a genetic 
condition where iron supplementation is unnecessary 
and can lead to harmful iron overload. Differentiating 
between these conditions is essential for accurate 
diagnosis and appropriate treatment, which is often 
challenging in the context of pregnancy due to the 
overlapping symptoms and the additional diagnostic 
complexities posed by the physiological changes of 
pregnancy.3-4 

The Mentzer Index has emerged as a helpful tool in this 
context, offering a simple and cost-effective method to 
differentiate between IDA and thalassemia trait. The 
Mentzer Index is calculated by dividing the mean 
corpuscular volume (MCV) by the red blood cell (RBC) 
count. In general, a Mentzer Index value below 13 
suggests thalassemia trait, while values greater than 13 
are typically indicative of iron deficiency anemia. The 
Mentzer Index can be a valuable initial screening tool to 
guide clinicians in further diagnostic workups, such as 
hemoglobin electrophoresis or serum ferritin testing, 
which are needed to confirm the diagnosis and 
determine the appropriate treatment course. Despite its 
usefulness, the Mentzer Index has limitations, including 
the fact that it may not accurately distinguish between 
other causes of anemia or when anemia is 

                     Open Access                                                                                                                                                                                                                Review Article                                                                           

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Emmanuel Ifeanyi Obeagu                                                                                                      Asian Journal of Dental and Health Sciences. 2025; 5(1):15-19 

[16]                                                                                                                                                                                                                                              AJDHS.COM 

multifactorial.5-6 In high-risk pregnancies, where the 
likelihood of anemia is elevated due to various maternal 
health factors, timely and accurate diagnosis is 
particularly crucial. The Mentzer Index allows 
healthcare providers to quickly narrow down the 
possible causes of anemia, which can accelerate 
treatment decisions and prevent the complications 
associated with both under-treatment and over-
treatment. For example, in cases where a woman with a 
low Mentzer Index is diagnosed with thalassemia trait, 
iron supplementation is avoided, preventing the risk of 
iron overload. Conversely, a higher score can prompt 
clinicians to initiate iron supplementation for those with 
IDA, thereby preventing further complications 
associated with iron deficiency.7-8 While the Mentzer 
Index is an effective screening tool, it should not be used 
in isolation, particularly in complex cases of anemia. 
Pregnancy-induced changes, such as altered iron 
metabolism, and the presence of other underlying 
conditions can sometimes interfere with the accuracy of 
the Mentzer Index. Additionally, in high-risk 
pregnancies, anemia is often multifactorial, which may 
require a more comprehensive approach to diagnosis 
and management. This includes combining the Mentzer 
Index with other diagnostic tests, such as serum ferritin, 
transferrin saturation, and hemoglobin electrophoresis, 
to ensure a more accurate understanding of the type 
and cause of anemia.9-10 

The Role of the Mentzer Index in High-Risk 
Pregnancies 

The Mentzer Index plays a critical role in managing 
anemia in high-risk pregnancies, particularly in 
distinguishing between two common causes of 
microcytic anemia: iron deficiency anemia (IDA) and 
thalassemia trait (TT). In high-risk pregnancies, where 
the prevalence of anemia is often higher due to factors 
such as pre-existing medical conditions, poor nutrition, 
or multiple gestations, accurately diagnosing the cause 
of anemia is crucial. Both IDA and TT present with 
similar symptoms, such as fatigue and pallor, but 
require different treatment approaches. While IDA 
responds well to iron supplementation, thalassemia 
trait does not, and inappropriate iron therapy can lead 
to iron overload, which can be harmful to the mother 
and fetus. The Mentzer Index serves as a simple, cost-
effective tool to help differentiate between these two 
conditions and guide further diagnostic workup and 
management.11-12 The Mentzer Index is calculated by 
dividing the mean corpuscular volume (MCV) by the red 
blood cell (RBC) count, yielding a numerical value. In 
general, a Mentzer Index score below 13 suggests that 
the anemia is more likely to be due to thalassemia trait, 
while a score above 13 is indicative of iron deficiency 
anemia. The use of this index in high-risk pregnancies 
helps to quickly identify whether further testing, such as 
hemoglobin electrophoresis or serum ferritin 
measurement, is needed to confirm the diagnosis. In 
women with a low Mentzer Index, confirming 
thalassemia trait is important, as iron supplementation 
would not be beneficial and could worsen the condition. 
Conversely, a high Mentzer Index can prompt the 
initiation of iron therapy for those with IDA, addressing 

the root cause of the anemia and preventing 
complications such as preterm birth and low birth 
weight.13-14 

Beyond its diagnostic utility, the Mentzer Index has 
significant implications for clinical practice in high-risk 
pregnancies. By using the index as a preliminary 
screening tool, healthcare providers can streamline the 
process of identifying anemia and initiate timely 
interventions. In the context of high-risk pregnancies, 
where maternal and fetal health are more vulnerable to 
complications from anemia, early diagnosis and 
appropriate treatment are crucial. The Mentzer Index 
provides a quick and easy way for clinicians to assess 
whether a pregnant woman is at risk for either IDA or 
thalassemia trait, ensuring that both conditions are 
managed appropriately. Moreover, by preventing the 
unnecessary administration of iron to women with 
thalassemia trait, the Mentzer Index helps avoid the risk 
of iron overload, which can lead to complications such 
as liver damage, heart failure, or gestational diabetes.15-

16 While the Mentzer Index is a valuable tool, it is not 
without its limitations, especially in complex cases. The 
physiological changes during pregnancy, such as altered 
iron metabolism and volume expansion, can sometimes 
affect the MCV and RBC count, potentially leading to 
inaccurate results. Additionally, anemia in high-risk 
pregnancies is often multifactorial, and other underlying 
conditions such as chronic disease or vitamin 
deficiencies could further complicate the diagnostic 
process. As such, the Mentzer Index should be used as 
part of a broader diagnostic strategy, incorporating 
other tests like serum ferritin, hemoglobin 
electrophoresis, and complete blood count (CBC) to 
provide a comprehensive understanding of the patient’s 
anemia.17 In high-risk pregnancies, the Mentzer Index 
proves to be a useful initial diagnostic tool, but it should 
not be relied upon as the sole determinant for treatment 
decisions. The index must be complemented with 
additional diagnostic tests to confirm the cause of 
anemia and to tailor the management strategy 
accordingly. It is essential for clinicians to incorporate a 
holistic view of the patient’s health status, considering 
factors like nutritional intake, preexisting conditions, 
and the overall clinical picture, to ensure that the 
appropriate interventions are taken. The role of the 
Mentzer Index in high-risk pregnancies lies in its ability 
to differentiate between two common causes of anemia, 
ultimately guiding treatment decisions that can improve 
maternal and fetal outcomes.18 

Anemia Screening in High-Risk Pregnancies 

Anemia screening in high-risk pregnancies is a critical 
aspect of maternal care, given the increased likelihood 
of anemia in women with underlying health conditions, 
poor nutrition, or multiple gestations. High-risk 
pregnancies often involve factors such as preexisting 
medical conditions (e.g., hypertension, diabetes, sickle 
cell disease), socioeconomic challenges, and nutritional 
deficiencies, which elevate the risk of developing 
anemia. Anemia during pregnancy can lead to serious 
complications for both the mother and fetus, including 
preterm labor, low birth weight, fatigue, and in severe 



Emmanuel Ifeanyi Obeagu                                                                                                      Asian Journal of Dental and Health Sciences. 2025; 5(1):15-19 

[17]                                                                                                                                                                                                                                              AJDHS.COM 

cases, maternal death. Therefore, early detection and 
proper management of anemia are essential for 
improving maternal and fetal health outcomes.19 The 
most common causes of anemia in pregnancy are iron 
deficiency anemia (IDA) and anemia due to other 
underlying conditions, including thalassemia, vitamin 
B12 deficiency, or chronic disease. Among these, IDA is 
the most prevalent form, characterized by insufficient 
iron stores needed for the production of hemoglobin. In 
contrast, thalassemia is a genetic blood disorder that 
can lead to microcytic anemia, which often presents 
similarly to IDA but requires different treatment, as iron 
supplementation is not beneficial for those with 
thalassemia. Given the overlap in clinical presentation 
between these two types of anemia, differentiating 
between them is crucial for appropriate management. 
Accurate screening tools, such as the Mentzer Index, are 
essential in guiding the diagnosis and helping clinicians 
determine the appropriate course of treatment.20 

Screening for anemia in high-risk pregnancies typically 
involves several stages, including a detailed clinical 
assessment, laboratory tests, and sometimes specialized 
diagnostic tools. The first step in anemia screening is 
often a complete blood count (CBC) to assess 
hemoglobin levels, mean corpuscular volume (MCV), 
and red blood cell count. If anemia is suspected, further 
tests such as serum ferritin, transferrin saturation, and 
hemoglobin electrophoresis may be necessary to 
confirm the underlying cause. For example, a low 
Mentzer Index score (MCV/RBC < 13) may suggest 
thalassemia trait, while a higher value typically points to 
IDA. By combining the Mentzer Index with other 
diagnostic tests, clinicians can quickly and effectively 
identify the cause of anemia, making it easier to 
determine whether iron supplementation is appropriate 
or if further investigation into thalassemia or other 
conditions is needed.21 The implementation of anemia 
screening in high-risk pregnancies has several key 
benefits, including early identification of anemia, 
reduced risk of complications, and targeted treatment 
plans. Early diagnosis of IDA allows for prompt iron 
supplementation, which can improve maternal energy 
levels, reduce fatigue, and lower the risk of preterm 
delivery and low birth weight. On the other hand, 
identifying women with thalassemia trait helps avoid 
unnecessary iron supplementation, preventing iron 
overload, which could lead to complications such as 
organ damage or gestational diabetes. Regular screening 
during prenatal visits allows healthcare providers to 
monitor hemoglobin levels and adjust treatment as 
necessary throughout the pregnancy, ensuring the best 
possible outcomes for both mother and child.22 Despite 
its importance, anemia screening in high-risk 
pregnancies faces several challenges. For one, the 
physiological changes in pregnancy, such as increased 
plasma volume and altered iron metabolism, can 
complicate anemia diagnosis. Pregnant women also 
often present with multifactorial anemia, where more 
than one cause contributes to the low hemoglobin 
levels. Furthermore, in resource-limited settings, access 
to diagnostic tools such as hemoglobin electrophoresis 
or serum ferritin tests may be limited, making it difficult 

to definitively diagnose the cause of anemia. Therefore, 
while anemia screening is essential, it must be 
integrated into a comprehensive approach to maternal 
care that includes clinical judgment, ongoing 
monitoring, and access to necessary diagnostic 
resources.23 

Implications for Anemia Management 

The implications of anemia management in high-risk 
pregnancies are significant, as anemia can have 
detrimental effects on both maternal and fetal health. 
Proper management is essential for preventing 
complications such as preterm labor, low birth weight, 
fatigue, and in severe cases, maternal mortality. The 
approach to managing anemia must be tailored to the 
underlying cause, which often involves differentiating 
between iron deficiency anemia (IDA) and other forms 
of anemia, such as thalassemia or anemia due to chronic 
diseases. The use of tools like the Mentzer Index plays a 
pivotal role in guiding the diagnosis, as it helps 
distinguish between these different causes, thereby 
informing the treatment strategy. Identifying whether 
the anemia is due to IDA or thalassemia allows clinicians 
to decide whether iron supplementation is appropriate, 
preventing unnecessary interventions that could lead to 
complications like iron overload.24 For patients with 
iron deficiency anemia, management primarily involves 
iron supplementation to replenish iron stores and 
support the production of hemoglobin. Oral iron 
supplements are commonly prescribed, but in cases of 
severe anemia or when oral supplements are not 
tolerated, intravenous iron may be used. Adequate iron 
intake not only alleviates fatigue and improves maternal 
well-being but also reduces the risk of adverse 
pregnancy outcomes, such as preterm birth, low birth 
weight, and fetal growth restriction. Additionally, 
managing anemia can help improve placental function, 
which is critical for optimal fetal development. On the 
other hand, thalassemia requires a different approach, 
as iron supplementation is contraindicated. In these 
cases, treatment focuses on managing the thalassemia 
trait, which may involve regular monitoring of 
hemoglobin levels, folic acid supplementation, and 
sometimes blood transfusions if anemia becomes 
severe.25 

Another crucial aspect of anemia management in high-
risk pregnancies is monitoring and adjusting treatment 
over time. Pregnancy itself brings about physiological 
changes that can affect iron metabolism and red blood 
cell production, which may impact anemia management 
strategies. Regular monitoring of hemoglobin levels and 
serum ferritin can help track the effectiveness of 
treatment and guide necessary adjustments. 
Additionally, for women with complex anemia profiles, 
such as those with both iron deficiency and thalassemia, 
managing the condition can be particularly challenging, 
requiring a multidisciplinary approach to care. For these 
women, ensuring that all aspects of their anemia are 
addressed is vital for preventing complications during 
pregnancy and labor.26 In high-risk pregnancies, a 
comprehensive anemia management plan should also 
take into account nutritional support, as malnutrition is 



Emmanuel Ifeanyi Obeagu                                                                                                      Asian Journal of Dental and Health Sciences. 2025; 5(1):15-19 

[18]                                                                                                                                                                                                                                              AJDHS.COM 

a key contributor to anemia, especially iron deficiency. 
Nutritional counseling can be an essential component of 
anemia management, as it helps ensure that pregnant 
women receive an adequate intake of iron, folic acid, 
and other essential nutrients. In resource-limited 
settings where access to iron supplements and 
diagnostic tests may be limited, educational 
interventions and community-based health strategies 
can help promote awareness about anemia prevention 
and treatment. Addressing the root causes of anemia, 
such as poor dietary intake or underlying health 
conditions like malaria or parasitic infections, is also 
crucial for improving maternal and fetal health 
outcomes.27 

Conclusion 

Anemia management in high-risk pregnancies is a 
crucial component of maternal and fetal healthcare, and 
early detection through effective screening tools like the 
Mentzer Index can significantly improve outcomes. The 
Mentzer Index, by differentiating between iron 
deficiency anemia (IDA) and thalassemia trait, plays a 
pivotal role in guiding the appropriate treatment 
approach, thus preventing complications associated 
with incorrect diagnoses and unnecessary treatments, 
such as iron overload. Timely and accurate 
identification of anemia causes ensures that women 
receive the most suitable intervention, whether iron 
supplementation for IDA or genetic counseling and 
management for thalassemia trait. 

However, it is essential to acknowledge that anemia in 
pregnancy can be multifactorial, and while the Mentzer 
Index offers a helpful starting point, it should be used in 
conjunction with other diagnostic tests and clinical 
evaluations. The physiological changes in pregnancy, 
along with the complexities of maternal health, can 
sometimes make anemia diagnosis challenging, 
requiring a comprehensive approach that includes 
clinical assessment, laboratory testing, and continuous 
monitoring. 

Conflict of Interest: Author declares no potential 

conflict of interest with respect to the contents, 

authorship, and/or publication of this article. 

Source of Support: Nil 

Funding: The authors declared that this study has 

received no financial support. 

Informed Consent Statement: Not applicable.  

Data Availability Statement: The data supporting in 

this paper are available in the cited references.  

Ethics approval: Not applicable. 

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Emmanuel Ifeanyi Obeagu                                                                                                      Asian Journal of Dental and Health Sciences. 2025; 5(1):15-19 

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