Update 3

As most of you told us the film shows microcytic red cells with occasional pencil cells and target cells. Some of you mentioned variable haemoglobinisation, some macrocytic cells, occasional spherocytes and suggested we check folate and vitamin B12 levels and investigate for hamolysis. 

As you told us the HPLC is normal. It shows no variant haemoglobin and the HbA2 is within normal limits suggesting no evidence of beta thalassaemia. 

The patient was given dietary advice as you suggested and we opted for a trial of daily dosing of 200mg ferrous sulphate. Recent BSH guidelines for iron deficiency in pregnant women now recommend 40-80mg of elemental iron daily as once daily dosing or alternate day dosing has been found to lower hepcidin levels and maximise fractional absorption of iron whilst reducing adverse effects.  Daily dosing is suggested as a practical compromise aiming for optimum compliance and more rapid response. 

We invited her to attend for a repeat full blood count 2 weeks later which was as follows:

  • Hb 91g/L
  • MCV 74fL
  • PLT 151×10*9/L
  • WCC 9.9×10*9/L

Questions:

  • What are your thoughts on the FBC now/?
  • Would you continue iron replacement? If so for how long?
  • What are the risks associated with iron deficiency in pregnancy?

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