Severe Megaloblastic Anemia & Thrombocytopenia in Pregnancy: A Case Report



Abstract Views
750

Downloads
822

Citations

Share

##plugins.themes.bootstrap3.article.sidebar##

Submitted Jan 23, 2023
Published Mar 18, 2023
10.24018/ejmed.2023.5.2.1667

Abstract viewed = 750 times

Table of Contents

##plugins.themes.bootstrap3.article.main##

Anemia during pregnancy is defined as a serum hemoglobin of less than 10.5 g/dL in the second trimester of pregnancy, and it is defined as a serum hemoglobin of less than 11 g/dL in the third trimester of pregnancy. There is evidence that maternal anemia raises the likelihood of health issues occurring in both the mother and the child. The anemia known as megaloblastic anemia is characterized by macrocytosis as a consequence of the reduction of DNA synthesis while erythropoiesis is taking place. This results in an increased number of red blood cells. The presence of megaloblastic anemia is often identified by chance during the course of routine blood testing. The only persons who have symptoms of anemia during pregnancy are those who already have a severe level of anemia. If treatment for megaloblastic anemia is not received, the condition may lead to thrombocytopenia. The first step in diagnosing megaloblastic anemia is identifying the morphological (increased mean cellular volume) and laboratory (specific vitamin deficiency) symptoms of megaloblastosis. This will lead to the identification of megaloblastic anemia. We take a look at the situation of a woman in her thirties who is expecting a child but has been told she has significant megaloblastic anemia and thrombocytopenia.

Keywords: anemia in pregnancy folic acid deficiency Megaloblastic anemia thrombocytopenia vitamin B12 deficiency

Downloads

Download data is not yet available.

References

  1. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐and middleincome countries. Annals of the New York Academy of Sciences. 2019; 1450(1): 15-31.
    DOI  |   Google Scholar
  2. Stephen G, Mgongo M, Hussein Hashim T, Katanga J, Stray-Pedersen B, Msuya SE. Anaemia in pregnancy: prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania. Anemia. 2018.
    DOI  |   Google Scholar
  3. Beckert RH, Baer RJ, Anderson JG, Jelliffe-Pawlowski II, Rogers EE. Maternal anemia and pregnancy outcomes: a population-based study. Journal of Perinatology. 2019; 39(7): 911-919.
    DOI  |   Google Scholar
  4. Adam I, Ibrahim Y, Elhardello O. Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematology. 2018; 18(1): 1-8.
    DOI  |   Google Scholar
  5. McLean E, de Benoist B, Allen LH. Review of the magnitude of folate and vitamin B12 deficiencies worldwide. Food Nutr Bull. 2008 Jun;29(2 Suppl): S38-51.
    DOI  |   Google Scholar
  6. Sayar EH, Orhaner BB, Sayar E, Nesrin Turan F, Küçük M. The frequency of vitamin B12, iron, and folic acid deficiency in the neonatal period and infancy, and the relationship with maternal levels. Turk Pediatri Ars. 2020; 55(2): 139-148.
    DOI  |   Google Scholar
  7. Patel P, Balanchivadze N. Hematologic Findings in Pregnancy: A Guide for the Internist. Cureus. 2021; 13(5).
    DOI  |   Google Scholar
  8. Obeagu EI, Babar Q, Obeagu GU. Megaioblastic Anaemia-A Review. Int. J. Curr. Res. Med. Sci. 2021; 7(5): 17-24.
     Google Scholar
  9. Patil AM. Management of a Case of Megaioblastic Anemia with Pancytopenia in late Pregnancy: A Case Review. Worid. 2018; 2(2), 61-65
    DOI  |   Google Scholar
  10. Ai-Khaffaf A, Frattini F, Gaiardoni R, Mimiola E, Sissa C, Franchini M. Diagnosis of anemia in pregnancy. Journal of Laboratory and Precision Medicine. 2020; 5(9): 1-5.
    DOI  |   Google Scholar
  11. Choudhary R, Koshti A, Malik R. Study of Morphological Pattern of Anaemia at a Tertiary Care Centre. Journal of Evolution of Medical and Dental Sciences. 2020; 9(8): 468-473.
    DOI  |   Google Scholar
  12. Lopes SC, Gadelha DD, Carvalho MDD, Fernandes VO, Montenegro Junior RM. Vitamin B12 deficiency: metabolic effects, clinical evaluation, and treatment. Rev Med UFC. 2019; 59(2); 40-49.
    DOI  |   Google Scholar
  13. Tran PN, Tran MH. Cobalamin deficiency presenting with thrombotic microangiopathy (TMA) features: a systematic review. Transfusion and Apheresis Science. 2018; 57(1): 102-106.
    DOI  |   Google Scholar
  14. Das S. Pancytopenia: An Update. Journal of Experimental Pathology. 2020; 1(1): 28-32.
    DOI  |   Google Scholar
  15. Waji ST, Gebremedhin A, Worku D, Teklu A, Abebe F, Jarso G, Woidemichaei T, et al. Risk factors for megaloblastic anemia related hematologic disorder among pregnant mothers attending ANC in Eastern Shoa Zone and the vicinity. A case control study. Ethiopian Medical Journal. 2019; 57(3).
     Google Scholar
  16. Jarso MD, Kissy Modle MSC. Determinants of megaloblastic anemia related hematologic disorder among pregnant mothers attending antenatal care in Eastern Shoa Zone: a case control study. Ethiop Med J. 2019; 57(2).
     Google Scholar
  17. Pishko AM, Marshall AI. Thrombocytopenia in Pregnancy. The American Society of Hematology. 2022; (1): 303-311.
    DOI  |   Google Scholar
  18. Eslick R, McLintock C. Managing ITP and thrombocytopenia in pregnancy. Platelets. 2020; 31(3): 300-306.
    DOI  |   Google Scholar
  19. Reese JA, Peck JD, Deschamps DR, McIntosh JJ, Knudtson EJ, Terrell DR, et al. Platelet counts during pregnancy. N Eng. J Med. 2018; 379(1): 32-43.
    DOI  |   Google Scholar
  20. Gutiérrez-Aguirre CH, Esparza-Sandoval AC. Differentiae diagnosis of thrombocytopenia in pregnancy. Medicina Universitaria. 2019; 21(1): 14-18.
    DOI  |   Google Scholar
  21. Fadiioglu E, Unai C, Tanacan A, Portakal O, Beksac MS. 5 Yearsʼ Experience of a Tertiary Center with Thrombocytopenic Pregnancies: Gestational Thrombocytopenia, Idiopathic Thrombocytopenic Purpura and Hypertensive Disorders of Pregnancy. Geburtshiife und Frauenheilkunde. 2020; 80(1): 76-83.
    DOI  |   Google Scholar
  22. Kim DJ, Venkataraman A, Jain PC, Wiesler EP, DeBlasio M, Klein J, et al. Vitamin B12 and folic acid alleviate symptoms of nutritional deficiency by antagonizing aryl hydrocarbon receptor. Proceedings of the National Academy of Sciences. 2020; 117(27): 15837-15845
    DOI  |   Google Scholar
  23. Hariz A, Bhattacharya PT. Megaloblastic anemia. StatPearis Publishing. 2021
     Google Scholar
  24. Janjgir S, Sharma M, Rajoria I, Mehta S. Fetal vascular adaptation before and after treatment of severe maternal anemia after 32 weeks of pregnancy. International Journal of Clinical Obstetrics and Gynaecology. 2019; 3(1): 89-91.
    DOI  |   Google Scholar
  25. Sharp A, Duong C, Agarwal U, Alfirevic Z. Screening and management of the small for gestational age fetus in the UK: a survey of practice. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018; 231: 220-224.
    DOI  |   Google Scholar
  26. Lalropuii, Sujatha TL, Ayisha B. The fetal biometry and doppler parameters on ultrasound among pregnant women complicated with moderate and severe anemia in third trimester. International Journal of Clinical Obstetrics and Gynaecology. 2021; 5(6): 155-158.
    DOI  |   Google Scholar
  27. Singh M, Rajoura OP, Honnakamble RA. Anemia-related knowledge, attitude, and practices in adolescent schoolgirls of Delhi: A cross-sectional study. Int J Health Allied Sci. 2019; 8(2): 144-148.
     Google Scholar
  28. Torrez, M, Chabot‐Richards D, Babu D, Lockhart E, Foucar K. How I investigate acquired megaloblastic anemia. International Journal of laboratory Hematology. 2022; 44(2): 236-247.
    DOI  |   Google Scholar
  29. Rashid S, Meier V, Patrick H. Review of Vitamin B12 deficiency in pregnancy: a diagnosis not to miss as veganism and vegetarianism become more prevalent. European Journal of Hematology. 2021; 106(4): 450-455.
    DOI  |   Google Scholar
  30. Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. British Journal of Hematology. 2012; 158(1): 3-15.
    DOI  |   Google Scholar
  31. Roberts I, Shakur-Still H, Afolabi A, Akere A, Arribas M, Brenner A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HAIT-IT): an international randomized, double-blind, placebo-controlled trial. The Lancet. 2020; 395(10241): 1927-1936.
    DOI  |   Google Scholar
  32. Grandone E, Mingalimov M A, Grigoryeva K N, Bitsadze V O, Shkoda AS, Khizroeva DK, et al. Thrombocytopenic syndromes during pregnancy. Obstetrics and Gynecology. 2019; 10: 5-12.
    DOI  |   Google Scholar
  33. Gonzalez-Velez M, Mead-Harvey C, Koslorek HE, et ai. Racial/ethnic differences in patients with anemia and folate deficiency. Int J Lab Hematoi. 2020; 42(4): 403- 410.
    DOI  |   Google Scholar
  34. Zhu XL, Feng R, Huang QS, Liang MY, Jiang M, Liu H, et al. Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study. Therapeutic Advances in Hematology. 2022; 13: 20406207221095226.
    DOI  |   Google Scholar
  35. Fogerty AE. Thrombocytopenia in pregnancy: mechanisms and management. Transfusion Medicine Reviews. 2018; 32(4): 225-229.
    DOI  |   Google Scholar
  36. Hernandez CMR, Oo TH. Advances in mechanisms, diagnosis, and treatment of pernicious anemia. Discovery Medicine. 2015; 19(104): 159-168.
     Google Scholar


Most read articles by the same author(s)