Book of Medical Disorders in Pregnancy - Tintash

lobed nuclei are common finding in
these cases.
Fig 1.4: Shows blood picture 9
different size and shape cells with few
granulocytes
Bone marrow biopsy - The bone
marrow aspirate will show megaloblast,
intermediate megaloblast and giant
metamyelocyte.
Diagnosis - The condition can be
diagnosed by analysis of clinical features
and cellular details of blood film and
bone morrow aspirate. Folic acid
deficiency can sometimes be demonstrated
by the FIGLU test which is based
on the increased level of formiminoglutamic
acid. When an oral dose of
histidine is given to a normal person it is
almost entirely converted to glutamic
acid and then to urea. If the patient is
deficient in folic acid. The metabolism
of histidine is stopped at the stage of
formiminoglutamic acid and this product
is then excreted in abnormally large
amounts in the urine. The value of this
substance (FIGLU) can be estimated
from the urine of the patient.
Serum Folate - Serum folates will be
found below 2 ng per ml in cases of
severe folic acid deficiency.
Refractory anaemia - This type of
anaemia is very rarely seen in
12
pregnancy. When the bone marrow has
been depressed by the action of drugs
such as gold, arsenic, phenacetin or
chloram-phenicol or by physical agents
such as radium or deep X-ray therapy.
Anaemia results. Some cases are caused
by a combination of iron and folic acid
deficiency.
Fig 1.5: Shows granulocyte in blood
picture
Chronic diseases such as tuberculosis,
rheumatoid arthritis, nephritis, and
leukemia may also depress the bone
marrow. Anemia caused by bone marrow
depression is usually very refractory
and will not respond to treatment unless
the causative factor has been removed.
When all these cases have been
excluded, there remains a small,
unexplained group of patients whose
anaemia remains refractory to all
treatments during pregnancy, but
recovers spontaneously within a few
months of delivery.
Hemoglobinopathies:
Anaemia due to the presence of
abnormal quality or quantity of
hemoglobin is not common in
pregnancy. In most of these disorders the
amount of normal hemoglobin A (adult
hemoglobin) in the red blood cells is
diminished, either because the body
cannot manufacture the globin necessary
to form hemoglobin A, as in thalassemia