Re: low hgb
From: Joe Cutchin (forcep@intercom.net)
Tue Jul 31 09:33:03 2007
Vicki: Where is she from orginally? I think there is a wierd Hb disease
in the carribean that manifests like this. Maybe Ef knows of it. It has
been published . Joe C
babycatchers@aol.com wrote:
> I wanted to see if any of you had any ideas on a case that we have now.
>
> For those of you who do not know, I am a CNM in practice (5 Years) with
> 2 OB/GYNS in a small rural hospital.
>
> 26 yo G3 P2 35 5/7 weeks. 3rd pregnancy in 5 years.
> First 2 pregnancies she was anemic, but not severely. On PNV, FE, folic
> acid and vit C. This pregnancy she has been anemic, but holding at
> about 10. Then about a month ago her hgb tanked and she started having
> bizarre symptoms.
> About 3 weeks ago she started having intermittent one sided numbness,
> slurred speech, confusion, disorientation and headaches. She would have
> an 'attack' that would last a couple of hours and then she would be
> fine. She said that she could 'sleep it off'. My first thought was
> migraines, but that doesn't explain the other symptoms. I was alone in
> the office that day.
> I called ER and the ER doc thought it was a panic attack and to have
> her come in when she had symptoms. In the office PEARL, grips equal
> bilat, symmetric movement, A & OX3, reflexes 2+, neg Babinski, HR 90s, R
> rate 30s, BP 92/50.(This is not THAT kind of patient). When she went
> into the ER about 3 days later, they diagnosed it as 'hyperventilation'
> and let her go home. Saw our OB that Thursday and was fine.
> On Friday afternoon she was found unconscious on her living room floor.
> No real idea of how long she had been there with the 2 other kids in the
> house. She was brought here- unresponsive to pain/anything- CT neg. We
> flew her out to the University Center. She was unconscious for about 30
> hours and then gradually started to wake up. They did a repeat CT
> (without contrast), labs and they tried to do an MRI which failed- for
> whatever reason.
> Hgb there was 6 something. They thought the neuro symptoms were 'complex
> partial migraines"- has anyone heard of such an animal?
> They sent her back to us last week to get 3 time a week IV FE infusion
> and monitoring. Baby is doing good- so far.
>
> I did the infusion last night because outpatient refused to do it
> because she is pregnant and the OB nurses needed some reassurance before
> they would do it on their own. The Hgb was 8.1, MCV was 32, and plt 161,
> WBC 11.4. The diff showed tear drop shaped cells, ovoid shaped cells and
> another one I can't remember.
> The OBs and I have discussed it and they like to know what you guys
> think about some of these strange things.
> Theory #1- Two separate problems that the pregnancy stressed her body
> enough to bring out symptoms this time.
> Theory #2- one of the funk-y thalasemia things that may have induced
> some vasulititis.
> Theory #3- well, we haven't really gotten there yet.
>
> She is to follow up with the Hematologist this week, but they want us to
> deliver her.
> The last time they sent one of these unknown patients back, she had a
> seizure at delivery and we had to chopper her back up there. That was
> about 2 months ago, so we are a little gun shy.
> Naturally she wants me for delivery. I delivered the other ones. The OB
> doesn't have a problem sitting at the desk and waiting in case anything
> happens, but I just want to know what to be ready for.
>
> Thanks for your ideas.
> Vicki
>
> Vicki Smith, CNM, MSN
> West Virginia
> Changing the world one baby at a time.
> ------------------------------------------------------------------------
> AOL now offers free email to everyone. Find out more about what's free
> ------------------------------------------------------------------------
> from AOL at AOL.com <http://www.aol.com?ncid=AOLAOF00020000000437>.
> ------------------------------------------------------------------------
|
|
