1. A woman presents with a low Hb in pregnancy. For the scenarios described, choose from the list the most likely diagnosis. Each option may be used once, more than once or not at all.

Possible Answers

For each of the questions below, select the answer which is most appropriate. Each option can be used once, more than once or not at all.

a.) Hb 9.5 g/dL. The patient is asymptomatic. Blood film shows reduced mean cell volume (MCV) and mean cell haemoglobin (MCH). Ferritin levels are reduced.

Choose from one of the following answersA Alpha thalassaemiaB Beta thalassaemiaC Iron deficiency anaemiaD Folic acid deficiencyE Sickle cell

b.) Hb is 10.0 g/dL. The patient is asymptomatic. Blood film shows increased MCV, hypersegmented neutrophils. She has a history of coeliac disease.

Choose from one of the following answersA Alpha thalassaemiaB Beta thalassaemiaC Iron deficiency anaemiaD Folic acid deficiencyE Sickle cell

c.) An Afro-Caribbean woman presents with chest pain and fever. Her GP has been treating her for hyperemesis and she appears dehydrated. Her Hb is 7.5 g/dL and she has a high reticulocyte count. Blood film shows target cells and Howell–Jolly bodies.

Choose from one of the following answersA Alpha thalassaemiaB Beta thalassaemiaC Iron deficiency anaemiaD Folic acid deficiencyE Sickle cell

d.) A woman of Mediterranean origin is treated in pregnancy with high-dose folate for anaemia. She has chronic anaemia and, outside of pregnancy, requires recurrent transfusions and has to have iron chelation therapy following this.

Choose from one of the following answersA Alpha thalassaemiaB Beta thalassaemiaC Iron deficiency anaemiaD Folic acid deficiencyE Sickle cell