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32 weeks pregnant, presented with fatigue, weakness ,shortness of breath ,lightheadedness ,palpitations,
no history of vaginal bleeding or bleeding from any other site. Her Hb at booking visit was 11.0g/dl, but now it
is found to be 9.5 g/dl. Indices of RBC’s was otherwise normal.
1.
2.
3.
4.
What is the diagnosis?
Why Hb fall down to this value?
When the drop is most significant?
What are the expected changes on the indices?
Answer (1):- Physiological anemia. The most common type of anemia in pregnancy.
Answer (2):- in pregnancy, there is increase in both plasma volume and red cell mass, but the increase in
plasma exceeds that of the red cell mass so, the red blood cells dilute.
Answer (3):- at 32 weeks gestation because plasma volume increase until the 32 nd week of gestation, then
it stops while red cell mass increases all through the pregnancy.
Answer (4):- Nothing. They are normal.
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14 weeks pregnant, presented with vaginal bleeding for 2 days, large in amount, also complained of chest
pain, dizziness, and palpitations. On examination she have tachycardia, cold skin and heart murmur. Her HB
is 9 g/dl. Low MCV and low MCHC..
1. What is the diagnosis?
2. What are other possible presentations could be ?
3. What are the treatment options?
4. What is the treatment if the gestational age was advanced, 32 for example, what are the possible side
effects?
5. what investigations you do to diagnose the case?
Answer (1):- Iron deficiency anemia. The commonest pathological and 2 nd commonest of anemia in
pregnancy.
Answer (2):- *get pregnant immediately after the previous pregnancy and now is lactating.
* Menorrhagia before getting pregnant, * poor intake as in heavy tea drinkers
* malabsorption disease * chronic illnesses such as liver disease or renal disease.
* chronic blood loss *hemolysis as in sickle cell disease.
Answer (3):- iron supplementation and a single 60mg tablet daily should suffice. If the woman is unable
to tolerate this because of common side effects, including nausea and constipation, different iron
preparations are available, including liquid formula.
Answer (4) :- blood transfusion, there is a small risk of antibody production and transfusion reaction.
Answer (5) :- *decrease in MCV and MCHC *decrease serum iron
*increase total iron binding capacity *decrease ferritin “source”

14 weeks pregnant, presented with Fatigue, weakness ,shortness of breath, lightheadedness, palpitations.
Her HB is 9 g/dl. High MCV but normal MCHC. Every thing otherwise is normal. She is currently taking
anticonvulsant therapy.
1.what is the diagnosis?
2.why?
3. Mention other possibilities that can cause folic acid deficiency anemia?
4.what is the treatment and what is the benefit?
5. what is the commonest cause of raised MCV worldwide?
6. mention another cause of macrocytic anemia and what is the incidence in pregnancy, and what is the
treatment?
7.what investigations you do to diagnose the case?
Answer (1):- Folic acid deficiency anemia
Answer (2):- because of high MCV and because she is taking anticonvulsant therapy which interferes with
folate consumption.
Answer (3) :- methotrexate (anti folate), hemolytic anemia
Answer (4) :- all women considering pregnancy should be encouraged to use folate supplementation (0.4 mg
daily) as it has been shown to reduce the incidence of neural tube defects.
Additional supplements (5g daily) are required in women receiving anticonvulsant medication.
Answer(5) :- alcohol consumption.
Answer (6) :- Vitamin B12 deficiency (pernicious anemia), unlikely to present in pregnancy, as sever cases
are associated with infertility. Diagnosed cases should continue vitamin B12 injections throughout gestation.
Answer (7) :- * increase MCV *decrease in serum folic acid
*decrease red cell folate “sometimes better because serum folate could be falsely high.
Done by: mujahid dauleh.