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Abnormal hemoglobinFrom: Terrence.Jones@ncal.kaiperm.orgWed Jan 22 21:30:42 1997
Betsy, sorry for the delay, just returned from Tahoe where, no kiddin', they're selling squeegees to scrape the powder from your glasses! Sounds like you're on the right track - refer to perinatology (+/-genetics) for counseling, and await final identification of the B-globin chain variant. As counseling will require knowledge of the paternal phenotype, a CBC (for MCV) and HgE4 (electrophoresis) makes good sense. You didn't mention the Hb A2; was it, like the Hb F, reported as nml? If you're curious, while awaiting results, check out the description of oligonucleotide primers in delta-beta fusion (Craig 3/94, Blood 83:1673-82), and keep in mind -- not all Lepore will have elev Hb F (Motum 5/93, Am J Hem 43:37-43). I'm resisting the urge to second Mats' skepticism on assigning an approp. control group in the NEJM prozac-in-pregnancy article until reading the entire text. Was trying in vain to resist commenting on Dr Marchbein's cultural comparison, of vasomotor instability description, between Japan & "here". Perhaps, in addition to "hot flash", we might add to the exclusionary lexicon: "wazoo"? Not wanting to detract from the significance of phyto- estrogens, but would like to re-inforce the notion that the (extremely) low incidence of breast ca has been attributed to dietary fat consumption; and this seems reproducible - worldwide. Like Dr Hellreigel, haven't yet come across any direct evid of progestin- protection of tamoxifen-related neoplastic endometrial fx. Not all advanced endometrial Ca remains receptive to progestin. Not every benign/atrophic endo- metrium will remain so in the presence of progestin. Lets count our "myc"'s & our "fos"'s while someone gathers some clinical data - meantime you might consult your Med-Onc, since they're usually receptive to megace for vasomotor sx's in this setting. Quien sabe? - you just might find less neoplastic endo metrial fx. As always, consultation with the Pt, in such circumstances, may be indicated... Waiting is... tj/ksf --------------------------( Enclosure 1 follows )---------------------------- Date: Monday, 20 January 1997 6:16pm --------------------------( Enclosure 1 follows )---------------------------- From: elishyde@connix.com (Betsy Hyde) --------------------------( Enclosure 1 follows )---------------------------- Subject: Abnormal hemoglobin Sender: ob-gyn-l@obgyn.net To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> Errors-to: ob-gyn-l-request@obgyn.net Precedence: bulk Originator: ob-gyn-l X-Comment: list for discussion of obstetrics and gynecology X-Listprocessor-version: 6.0c -- ListProcessor by Anastasios Kotsikonas Reply-To: elishyde@connix.com A 23 yo G1, twin gestation had hemoglobin electrophoresis done because of low MCV. Not anemic. Hemoglobin electrophoresis came back with no abnormal amounts of S, C, F, thal but 12% "unknown" hemoglobin. Lab unable to identify. Says the hemoglobin migrated in area similar to, but not identical, to hemoglobin Lapour (?spelling) What to do? Check FOB for hemoglobinopathies? Do nothing? (Have referred to local perinatologists who are also bewildered but are consulting with pediatric hematologist) Betsy Hyde CNM Branford, CT midwife in private md/cnm practice
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