w*******7
发帖数: 412 | 1 otherwise health young pregnant women is found to have macrocytic anemia in
her 2nd trimeter. Has been taking prenatal vitamin through the pregancy (
including 1mg folate acid) and extra oral VB12 3000mcg daily for 2 months.
Hb is still around 11g/dL and MCV around 102. serum VB12 level is 718pg/mL (
211~911).
Methylmalonic acid serum level is 113nmol/L (87~318), Homocysteine level is
6.6(5.5~15).
patient's 36 weeks prenatal ultrasound found fetal weight 5.5lbs(25%), while
AC(abdominal circumstance)value is 29 (4.5%). while patient gained 36lbs
within past 36weeks.
Question: what's the next step of work-up? possible differential diagnosis
and treatment? will you consider do thyroid work up?
我是穷人一个,谁说的有理都给包子等发完为止. |
I****a
发帖数: 407 | 2 What is the severity of her anemia? TSH, reticount and a smear will help.
ETOH history is also important. |
c**********m
发帖数: 2088 | 3 An underactive thyroid gland can lead to macrocytic anemia. 近10个孕妇中有1
个患甲减。
甲状腺功能减退简称甲减常伴有贫血，其发生率约占甲减患者的1/3—1/2，多数为轻、
中度正常血红蛋白或低血红蛋白小红细胞型贫血，少数为恶性贫血(大细胞性贫血)。那
么甲减性贫血的发病机制是什么呢？
(1)甲状腺激素有促进红细胞生成的功能，当甲减时甲状腺分泌减少，骨髓因缺乏
甲状腺激素而特异性受抑，呈增生不良，减少了红细胞生成素的促进物质之一，使红细
胞生成素减少而致贫血。
(2)甲减病人厌食，胃酸缺乏，约半数病例可继发有吸收减少，蛋白质与维生素B12吸收
减少，以及其它营养物质摄入减少，引起营养不良性贫血，①甲减时血容量减少，约有
32％—84％的病例血红蛋白可低至80—90g/L；以及月经过多大量失血也可导致贫血；
②某些病人因胃内因子缺乏使维生素B12吸收减少，造成大细胞性贫血，另甲减病人中
抗甲状腺抗体检出率相当高，因此认为发生大细胞性贫血可能与自身免疫对胃粘膜的损
害有关。 |
A*******s
发帖数: 9638 | 4 Your MCV is not that bad. I would do folate 4 mg daily if nothing else could
be found. |
