Thirty years old G4P3L3 with 32 weeks pregnancy with single live fetus in cephalic presentation, Patient complains of easy fatigability and weakness since last 3 months which has gradually increased over last 15 days to an extent that she gets tired on doing household activities. Patient also complaints of breathlessness on exertion since last 15 days. Patient gets breathless on climbing 2 flight of stairs. It is not associated with palpitations or any chest pain. There is no history of pedal edema, sudden onset breathlessness, cough or decreased urine output. There is no history of asthma or chronic cough. There is no history of chronic fever with chills or rigors. There is no history of passage of worms in stool nor blood loss from any site. There is no history of easy bruisability or petechiae. There is no history of yellow discoloration of urine, skin or eyes. She did not take iron folate prophylaxis throughout her pregnancy.* She is suspected to be anemic and her blood sample was ordered for examination which showed.* Hb 7.4 gm% (12-14 gm%)* Hct 22% (36-44%)* MCV 72 fL (80-97 fL)* MCH 25 pg (27-33 pg)* MCHC 30% (32-36%)* Peripheral smear shows microcytic hypochromic RBCs with anisopoikilocytosis* Naked eye single tube red cell osmotic fragility test (NESTROFT) is negative. What is the most probable diagnosis:
Ans. is b, i.e. Iron deficiency anemiaIn the question patient has Hb 7.4 gm%, hematocrit 22% and symptoms of early fatigue, which indicate she is anemic. Her complete blood picture shows MCV and MCH are low indicating microcytic anemia. Thus differential diagnosis could either be Iron deficiency anemia or thalassemia.Her NESTROFTS test (screening test for thalassemia) is negative, hence thalassemia is ruled out and diagnosis is confirmed as Iron deficiency anemia.
Thalassemia
Iron deficiency anemia
Megaloblastic anemia
Vitamin B12 deficiency anemia.
Physiological changes during Pregnancy