Thirty years old G4P3L3 with 32 weeks pregnancy with single live fetus in cephalic presentation, Patient complains of easy fatigability and weakness since last 3 months which has gradually increased over last 15 days to an extent that she gets tired on doing household activities. Patient also complaints of breathlessness on exertion since last 15 days. Patient gets breathless on climbing 2 flight of stairs. It is not associated with palpitations or any chest pain. There is no history of pedal edema, sudden onset breathlessness, cough or decreased urine output. There is no history of asthma or chronic cough. There is no history of chronic fever with chills or rigors. There is no history of passage of worms in stool nor blood loss from any site. There is no history of easy bruisability or petechiae. There is no history of yellow discoloration of urine, skin or eyes. She did not take iron folate prophylaxis throughout her pregnancy.* She is suspected to be anemic and her blood sample was ordered for examination which showed.* Hb 7.4 gm% (12-14 gm%)* Hct 22% (36-44%)* MCV 72 fL (80-97 fL)* MCH 25 pg (27-33 pg)* MCHC 30% (32-36%)* Peripheral smear shows microcytic hypochromic RBCs with anisopoikilocytosis* Naked eye single tube red cell osmotic fragility test (NESTROFT) is negative. What is the most probable diagnosis:
Thirty years old G4P3L3 with 32 weeks pregnancy with single live fetus in cephalic presentation, Patient complains of easy fatigability and weakness since last 3 months which has gradually increased over last 15 days to an extent that she gets tired on doing household activities. Patient also complaints of breathlessness on exertion since last 15 days. Patient gets breathless on climbing 2 flight of stairs. It is not associated with palpitations or any chest pain. There is no history of pedal edema, sudden onset breathlessness, cough or decreased urine output. There is no history of asthma or chronic cough. There is no history of chronic fever with chills or rigors. There is no history of passage of worms in stool nor blood loss from any site. There is no history of easy bruisability or petechiae. There is no history of yellow discoloration of urine, skin or eyes. She did not take iron folate prophylaxis throughout her pregnancy.* She is suspected to be anemic and her blood sample was ordered for examination which showed.* Hb 7.4 gm% (12-14 gm%)* Hct 22% (36-44%)* MCV 72 fL (80-97 fL)* MCH 25 pg (27-33 pg)* MCHC 30% (32-36%)* Peripheral smear shows microcytic hypochromic RBCs with anisopoikilocytosis* Naked eye single tube red cell osmotic fragility test (NESTROFT) is negative. What is the most probable diagnosis:
💡 Explanation
## **Core Concept**
The patient presents with symptoms of anemia, such as easy fatigability, weakness, and breathlessness on exertion, during her 32nd week of pregnancy. The laboratory findings confirm anemia with low hemoglobin (Hb) and hematocrit (Hct) levels. The key to diagnosing the type of anemia lies in interpreting the red blood cell (RBC) indices and the peripheral smear report.
## **Why the Correct Answer is Right**
The patient's laboratory results show:
- Low Hb (7.4 gm%) and Hct (22%)
- Microcytic hypochromic RBCs on the peripheral smear
- Low MCV (72 fL), MCH (25 pg), and MCHC (30%)
- Negative NESTROFT
These findings are characteristic of **iron deficiency anemia**, which is common in pregnancy due to increased iron demands and inadequate dietary intake or prophylaxis, as indicated by the patient's lack of iron and folate prophylaxis throughout her pregnancy.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Without specific details on the options, we can infer based on common causes of anemia in pregnancy:
- **Thalassemia** (if considered) is less likely due to the negative NESTROFT, which suggests normal osmotic fragility of RBCs.
- **Folate deficiency** typically presents with macrocytic anemia, not microcytic hypochromic anemia.
- **Anemia of chronic disease** and other causes might present differently and are less directly linked to the specific laboratory findings and clinical context provided.
## **Clinical Pearl / High-Yield Fact**
A crucial point to remember is that **iron deficiency anemia** is the most common type of anemia in pregnancy, especially in regions with inadequate nutrition or without routine iron supplementation. The negative NESTROFT helps to differentiate it from hereditary spherocytosis and thalassemia, where osmotic fragility is typically increased.
## **Correct Answer:** C. Iron deficiency anemia.
✓ Correct Answer: B. Iron deficiency anemia
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