The patient is a pregnant female, 7 months gestation, who has a routine screening test for...
The patient is a pregnant female, 7 months gestation, who has a routine screening test for hemoglobin and hematocrit. Both are decreased with an elevated MCV (125fL), elevated RDW and normal MCHC. Her white blood cell count is normal and her platelet count is minimally decreased. Review of the peripheral smear revealed macro-ovalocytes, anisocytosis, teardrop cells, and a rare Howell-Jolly body.
What blood tests would you like to see at this
point?
Her serum iron is normal, serum ferritin is normal, TIBC is mildly
elevated, and serum B 12 is normal. Her serum folate level is low
and her red blood cell folate level is low.
What is the diagnosis?
How should she be treated?
Homework Answers
The blood picture is of megaloblastic anemia so the blood tests should be advised is
1.Serum Folate and serum Vit B12 estimation
2.Also Homocysteine estimation in blood (Folate deficiency as this case suggests.) Folate in 5 methyl THFA form is a co substrate required by.methionine synthase when it converts homocysteine to methionine. As a result of Folate deficiency homocysteine accumulates which is associated with atherosclerotic diseases.
As it is a case of megaloblastic anaemia due to folic acid deficiency,Folic acid supplements should be started .with enough dietary leaffy vegetable ,eggs etc and complete stoppage of alcohol.
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