OB/GYN
A 34-year-old woman G5 P4004 presented to with amenorrhea, tiredness, nausea and vomiting during the morning…
A 34-year-old woman G5 P4004 presented to with amenorrhea, tiredness, nausea and vomiting during the morning hours for 3 months. Human chorionic gonadotropin test was positive. A physical examination showed no swelling in the lower extremities. The thyroid was enlarged on palpation. The tongue, conjunctiva and nail beds appeared pale. The uterine fundus was palpable 3 cm above the pubic symphysis. A peripheral blood smear showed macrocytic red blood cells and hypersegmented neutrophils (see lab results). Blood pressure 100/60 mmHg, Heart rate 120 /min, Respiratory rate 26 /min, Temperature 37.0° C oral. Test Result Normal Values: Hb 85 (120-160 g/L), HCT 0.32 (0.37-0.48), MCHC 332 (320-360 g/L), MCV 100 (80-95 fl), Thyroid-Stimulating Hormone 0.44 (0.4 - 5.0 uIU/L). Which of the following is the most appropriate treatment?
الشرح
Core Concept: Megaloblastic anemia in pregnancy is most commonly caused by folate deficiency, as the fetal demand for folate significantly increases maternal requirements. The presence of hypersegmented neutrophils and macrocytosis (MCV 100) confirms a megaloblastic process. Clinical Presentation:
- Fatigue, weakness, pallor (anemia).
- Glossitis, gastrointestinal symptoms.
- Neurological symptoms are absent (which helps differentiate from B12 deficiency).
Diagnosis: First-line is a CBC showing macrocytic anemia (elevated MCV) and a peripheral smear revealing macro-ovalocytes and hypersegmented neutrophils. Serum folate and Vitamin B12 levels are the gold standard to differentiate the specific deficiency. Management: Acute management involves replenishing the deficient vitamin. The gold standard long-term management for folate deficiency anemia in pregnancy is high-dose oral folic acid supplementation (e.g., 1-5 mg daily) alongside a folate-rich diet, which rapidly corrects the hematologic abnormalities.