Re: low hgb
From: Betsy Hyde (elishyde@mindspring.com)
Tue Jul 31 11:38:51 2007
has she had a hemoglobin electrophoresis? Could these be neurologic
manifestations of sickle crisis?
--
Betsy Hyde CNM
Branford, CT
On Jul 31, 2007, at 11:15 AM, babycatchers@aol.com wrote:
> I asked her about genetic origins last night and she stated that
> the family had no idea. She is darker skinned for around here (WV
> mountains) but she thinks her grandmother was 'placed' from another
> family. So I don't know.
> Vicki
>
> Vicki Smith, CNM, MSN
> West Virginia
> Changing the world one baby at a time.
>
> -----Original Message-----
> From: Joe Cutchin <forcep@intercom.net>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> Sent: Tue, 31 Jul 2007 10:33 am
> Subject: Re: low hgb
>
> 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.
> >
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