Instructions
You are a medical student on placement in general practice. Your next patient is Adut Kuol, 27, who is 28 weeks pregnant and has been feeling tired. She is back for her routine 28-week blood results, which are below.
Take a focused history
Explain the results and your management plan to the patient
- You do not need to examine the patient
- You do not need to summarise your findings to the examiner
Full blood count
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin (28 weeks) | 92 g/L | 110-150 g/L |
| Haemoglobin (booking, 10 weeks) | 112 g/L | 110-150 g/L |
| MCV | 74 fL | 80-100 fL |
| MCH | 23 pg | 27-33 pg |
| White cell count | 9.4 x10^9/L | 4.0-11.0 x10^9/L |
| Platelets | 236 x10^9/L | 150-400 x10^9/L |
The reference range at 28 weeks is the third-trimester range.
Iron studies and other antenatal bloods
| Item | Value | Reference range |
|---|---|---|
| Ferritin | 8 ug/L | 30-200 ug/L |
| Transferrin saturation | 7% | 15-45% |
| Haemoglobin electrophoresis (booking, 10 weeks) | Normal pattern; no variant haemoglobin detected | - |
| 75 g glucose tolerance test (28 weeks) | Fasting 4.5, 1 hour 7.8, 2 hours 6.4 mmol/L | <5.1 fasting, <10.0 at 1 hour, <8.5 at 2 hours mmol/L |