A 28 year old woman at 31 weeks gestation attends the antenatal clinic. Her full blood count was taken when she was 28 weeks which results shows:
Haemoglobin 10.6 g/dL Mean cell volume 96 fL Mean cell haemoglobin concentration 350 g/L
What is the SINGLE most appropriate management?
A. Offer folate supplements
B. Offer iron dextran
C. Offer ferrous sulphate
D. Explain that this is physiological haemodynamic anaemia
E. Offer vitamin B12 supplements
The values of anaemia differ in pregnancy as compared to a non pregnant women.
The British Committee for Standards in Haematology has defined anaemia in pregnancy as the following values Hb levels of: <11.0g/dl in the first trimester <10.5 g/dl in the second and third trimesters <10.0 g/dl in the postpartum period.
Since her Hb level is above 10.5g/dL, she does not need iron tablets.
This is one of the questions that differ in terms of how you answer in PLAB and how you would act in real life. While the British Committee of Standards in Haematology have gave strict definitions of when to give iron tablets, in real life, many gynaecologist would have prescribed iron tablets in this case. Again, it depends on hospital guidelines. But for the PLAB test, it is important to follow national guidelines.