Case 45 – update 1

So far we have a women who is 11 weeks pregnant and feeling tired and out of sorts. She has a microcytic anaemia and a borderline platelet count. Firstly let’s think about the anaemia. The two most common causes of anaemia in pregnancy are:

  • Iron deficiency
  • Haemoglobinopathy

Anaemia is exacerbated in pregnancy due to:

  • Increase in red cell mass
  • Blood loss
  • Increased maternal iron requirements
  • Iron needed by foetus and placenta
  • Dilution – increase in plasma volume

The MCV increases in pregnancy usully by 6Fl by about 26 weeks, so to have a microcytic picture would be unusual during pregnancy unless the patient has significant iron deficiency or a pre-existing haemoglobinopathy.


  • What would you want to know before starting iron supplementation?
  • Are there any risks to iron supplementation?
  • When would you consider intravenous iron?
  • Which women are at risk of iron deficiency during pregnancy?
  • Why should iron be replaced? What are the risks of not replacing?

Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #TeamHaem on Twitter for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

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Online education and discussion about all things haematological
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