Case 45 – update 3

The blood film in the earlier post has been reported as :

Microcytic anaemia with no specific features of iron deficiency or haemoglobinopathy; suggest check iron status

The HPLC shows no variant haemoglobin and the HbA2 is within normal limits suggesting no evdience of beta thalassaemia. Alpha thalassaemia trait cannot be ruled out here but looking back through old full blood counts the Hb and MCV have been normal. Therefore the diagnosis is iron deficiency.

In three weeks time the FBC shows:

  • Hb 99g/L
  • MCV 76fL
  • PLT 121×10*9/L
  • WCC 9.9×10*9/L (normal white cell differential)

She is clearly responding to iron therapy and so continues with iron replacement.

By 36 weeks her blood tests are checked again:

  • Hb 118g/L
  • MCV 86fL
  • PLT 95×10*9/L
  • WCC 10.1×10*9/L (normal white cell differential, except for mild neutrophila)

Questions:

  • What are the causes of thrombocytopenia in pregnancy?
  • How do you assess the patient?

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.

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