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Case Discussion: Low Hb

Case Discussion: Low Hb. May 2014. Consider Jyoti …. Jyoti is a 26 yo G3 P0 currently 28 weeks gestation who presents to you for follow up of her 28 week blood test performed by your colleague You note that a Hb only was performed on this occasion; result 109 g/L (normal 110-150g/L)

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Case Discussion: Low Hb

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  1. Case Discussion: Low Hb May 2014

  2. Consider Jyoti… • Jyoti is a 26 yo G3 P0 currently 28 weeks gestation who presents to you for follow up of her 28 week blood test performed by your colleague • You note that a Hb only was performed on this occasion; result 109 g/L (normal 110-150g/L) • On checking her notes the previous CBP performed at 12 weeks was 110g/L and showed a hypochromic microcytic red cell picture, with target cells & elliptocytes which was also highlighted in the comment from the laboratory • Only standard pregnancy investigations results are filed in her notes and recorded in her pregnancy hand held record • What else would you like to know?

  3. Further Information: • From your consultation and review of her notes you discover: • Jyoti is of Nepalese origin • No follow up testing was performed at 12 weeks. However, your colleague did advise her to commence some iron which she has been taking irregularly, but generally a few times a week • What is your differential diagnosis? • Would you like to perform any further tests?

  4. Further Tests… • You further decide to : • repeat her full CBP • perform iron studies • perform thalassaemia screening

  5. Further information… • Jyoti returns for explanation of the follow up bloods you performed: • CBP: • Hb 109g/L normochromic, normocytic picture, normal platelets & WBC • iron studies: • Ferritin 23ng/L (15-150) • Iron 35nmol/L (8-27) H • Transferrin sat 37% (10-35) H • Transferrin 3.73g/L (3.17-5.56) • thalassaemia screening: • nil evidence of deletion form of alpha thalassaemia • Normal level of HbA2 7 HbF did not suggest beta thalassaemia trait • How do you explain Jyoti’s results through this pregnancy? • What are the important learning points from this case?

  6. Take Home Messages… • In iron deficiency, microcytosis can precede anaemia • Abnormal cell morphology commonly seen in haemoglobinopathies such as target cells, elliptocytes, poikolocytes, frequently occur in iron deficiency • Investigations may include: Iron studies, B12, folate,Hb electrophoresis & alpha thalassaemia gene testing • Test partner if woman positive for thalassaemia

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