Re: low hgb
From: art fougner, md (evsono@pipeline.com)
Wed Aug 1 07:27:02 2007
>From the info presented, your patient has apparently a hemolytic anemia
and seizures. I would follow the group's suggestion and get Heme
involved ASAP. As Garry pointed out, at 36 wks, the exit door is always
available. The distinct possibility exists of another shoe waiting to
drop in postpartum period. The work-up should be expedited.
Art
At Wed, 1 Aug 2007, Raymond Stephen wrote:
>
>Sickle cell anaemia will explain all these signs and symptoms. But "3
>TIME A WEEK IV FE INFUSION"!!! Crikey, you'll have her swinging
>North/South in the bath with that! Oral iron works just as well, and
>without the risk of anaphylaxis. Besides, from memory, Iron is
>contraindicated in Sickle Cell.
>
>Steve
>
>________________________________
>
>________________________________
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>
>--
>________________________________
>babycatchers@aol.com
>________________________________
>Sent: Wednesday, 1 August 2007 12:00 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: low hgb
>
>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
>
>CONFIDENTIALITY NOTICE AND DISCLAIMER
>
>other purpose.
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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