Re: low hgb
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Jul 31 09:16:03 2007
Consider Pernicious Anemia.
Hgb Electorphoresis?????
Iron studies?????
HELLP Syndrome with internal bleeding
Dan
On 7/31/07, babycatchers@aol.com <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.
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--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
