Exxcellence pearls: anemia in pregnancy Flashcards
How is anemia in pregnancy defined?
What is the most common cause?
What are risk factors?
Hemoglobin less than or equal to 11 g/dL. (WHO considers 10.5 g/dL in 2nd trimester.)
Iron deficiency
Low socioeconomic status, malnutrition, multiple gestation, history of menorrhagia, short interval between pregnancies
How should MCV less than 80 be evaluated at initial presentation?
Serum ferritin and hemoglobin electrophoresis
Low ferritin is diagnostic of iron deficiency. Hemoglobin electrophoresis will detect sickle cell disease and hemoglobinopathies.
What does Hb A2 greater than 3.5% with normal ferritin indicate?
What is on the differential if Hb A2 is less than 3.5%?
Beta thalassemia
Alpha thalassemia, hemoglobin H disease and chronic anemia
What is the next appropriate lab if hemoglobin is less than 11 and MCV is greater than or equal to 80?
What would a low level indicate?
What does anemia with MCV greater than 100 indicate?
reticulocyte count
Iron, folate, or B12 deficiency, or chronic disease
Low reticulocyte count with MCV greater than equal to 100 is consistent with folate or B12 deficiency. Serum folate and B12 should be evaluated
What does high retic count mean? How should it be evaluated?
What is the differential diagnosis?
Suggestive of hemolysis and should prompt a peripheral smear, direct Coombs’ test and hemoglobin electrophoresis.
Glucose-6-phosphate dehydrogenase deficiency or blood loss
What ethnicities are at risk for G6PD deficiency?
Mediterranean, Asian, Middle Eastern, Hispanic, West Indies and African descent
