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Case 1
Haemostasis
Answers
Case Description
A 20-year-old woman is 32/40 weeks pregnant. She attends the antenatal clinic for a routine check up. A Full Blood Count [FBC] is performed and you are asked to see her because of the following results:
| TEST | PATIENT | REFERENCE RANGE |
|---|---|---|
| Hb | 101 g/L | 115-135g/L |
| WCC | 6.2 x 10^9/L | 6-10 x 10^9/L |
| Platelets | 80 x 10^9/L | 150-400 x 10^9/L |
| MPV | 13.1 fL | 7.5-9.2 fL |
| MCV | 89 fL | 80-98 fL |
| Differential WCC | Normal | - |
1. What do these results show and what are the possibilities to explain these findings?
2. What additional investigations would you request?
You request:
- A platelet count using citrate as an anticoagulant - the platelet count is 78 x 109 /L
- A blood film is reported as normal and in particular no platelet clumps are seen.
- A screen for anti-phospholipid antibodies is negative.
- The ANA is positive and the ENA shows the presence of Anti-Ro [Titre: 60 U/mL [<8 U/mL]] and Anti-La antibodies [Titre: 70U/mL [<8 U/mL]].
What will you do next?
At 36 weeks the platelet count is 62 x 109 /L.
1. Normocytic anaemia, thrombocytopenia with large platelets
2. Platelet count with citrate, blood film, anti-phospholipid antibodies, ANA
Ask for a repeat platelet count in 4 weeks.
What advice will you give to the obstetricians and the obstetric anaesthetist?
No answer given.
The advice you should have given is: