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Dr. Andrew Rynne

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Pregnant. Blood test, peripheral smear and urine analysis done. Does it indicate any abnormality?

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Dr. S Patra

OBGYN

Practicing since :2011

Answered : 4047 Questions

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Posted on Wed, 6 Feb 2013 in Women's Health
Question: My wife is in 1st trimester of her pregnancy and we got all the required test done last week. The reports summary is here:

Blood Test
HB: 12.3 g/dl (11.5 - 16.5 g/dl)
PCV : 36.9 % (37-47 %) - ABNORMAL VALUE

RBC : 4.12 millions/cumm
MCV : 87.1 fl (76 - 96 fl)
MCH : 28.6 pg (27 - 32 pg)
MCHC : 33.4 g% (32 - 36 g%)

Total Count : 10, 800 cells/cumm (4000 - 0000 cells/cumm) - ABNORMAL VALUE
Neutrophils : 72% (40 - 75%)
Lymphocytes : 14% (20 - 45%) - ABNORMAL VALUE
Eosinophils : 02% (0 - 6%)
Monocytes : 02% (2 - 8%)
Platelet count : 1.90 Lakhs/cumm (1.5 - 4.5 Lakhs/cumm)
ESR : 20 mm/hr (0 - 20 mm/hr)

Peripheral Smear
RBCs : Normocytic Normochromic
WBCs : Normal in morphology
PLATELETS: Adequate
HAEMOPARASITES: Not Seen
ABNORMAL CELLS: Not Seen
IMPRESSION: NORMOCYTIC NORMOCHROMIC BLOOD PICTURE

-----------------------------------------
Randam Blood Sugar: 104 mg/dl (70-150 mg/dl)
Randam Urine Sugar: Nil
-----------------------------------------
VDRL: Non Reactive
HBSAG: Negative
HIV ELISA: Negative
-----------------------------------------
Urine Analysis:

Physical Examination
Volume: 25 ml (20-30 ml)
Color: Pale Yellow (Pale Yellow)
Appearance: Turbid (Clear)
Specific Gravity: 1.010 (1.008-1.028)
PH: 6.0 (5.2 - 6.7)

Chemical Examination
Albumin: Trace (Negative)
Sugar: Negative (Negative)
Ketone bodies: Negative (Negative)
Bile Salts: Negative (Negative)
Bile Pigments: Negative (Negative)
Urobilinogen: Normal Amount (Normal Amount)

Microscopic Examination
Epithelial Cells: 4-6/hpf* (2-3/hpf) - ABNORMAL VALE
PUS Cells: 8-10/hpd* (0-1/hpf) - ABNORMAL VALUE
RBC: Nil (Nil)
Casts: Nil (Nil)
Crystals: Nil (Nil)
Bacteria: Present (Nil)

------------------------------------------
T3T4TSH
TRI-IDOTHYRONINE T3 : 166.29 ng/dl (60.00 - 181.00 ng/dl)
THYROXINE T4 : 9.90 ug/dl (4.50 - 12.60 ug/dl)
THYROID STIMULATING HORMONE TSH: 11.56 (H) uIU/ml (0.35 - 5.50 uIU/ml) - ABNORMAL VALUE

Certain paramaters like PCV, Total Count, Lymphocytes in Blood Test, Epithelial & PUS Cells with Bacteria presence in Urine Test, and high TSH value in Thyroid Test are a reason to worry.

She works everyday from 8 AM to 5 PM and travels nearly 1.5 hour every day. Currently, she is in her 11th week and would be completing 12th week on 24th of this month. Her 6th week scan was normal but there was a minute bleeding(just a drop) in 8 week but scan was normal so she was advised a bed rest for 10 days. Planning to visit a doctor tomorrow but still I want to take an expert opinion on these reports.

Regards,
XXXXXXX
doctor
Answered by Dr. S Patra 9 hours later
Hello XXXXXXX

Thanks for posting query. I have gone through all reports of your wife in details.

I will try explaining the reports according to abnormal findings & your query.

1) PCV 36.9% - Pregnancy usually causes a slightly decreased PCV due to extra fluid in the blood. It is quite normal & a physiological thing.

2) Increasing TLC (10,800 cells/cumm) with slight decreasing Lymphocyte count (14%) are also normal physiological findings in pregnancy.

3) In urine analysis, Epithelial cells 4-6/ HPF & Pus cell 8-10/ HPF with presence of bacteria suggest asymptomatic bacteriuria. It may be associated with stasis of urine due to the ureters dilate from the effect of the hormone progesterone in pregnancy. It is quite a normal phenomena.

The normal pus cells in urine during pregnancy are same as compared to non pregnant states. The normal range should be from 6 to 10 pus cells per ml/ HPF. A high number than normal range indicate UTI) and the condition is known as pyuria.

Here I suggest URINE CULTURE to rule out asymptomatic UTI.

4) TSH level 11.56 uIU/ml is high enough than normal. It suggests hypothyroidism in your wife and she needs to start treatment for that at the earliest.

Certain complication may arise as miscarriages, anemia, Preterm delivery, abruptio placenta, pre-eclampsia & postpartum hemorrhage (PPH) in pregnant women with overt hypothyroidism. Congenital hypothyroidism in growing fetus is also a complication and it may hamper IQ of baby.

Levothyroxine is the treatment of choice for hypothyroidism in pregnancy. Early treatment can eliminate above complication.

5) Slight spotting is normal in early week of pregnancy. As her ultrasound is normal with fetal well being, then you should not be worried.

Do some basic things for healthy pregnancy:
1) Continue prescribed medicine. She will need Thyroid tablets also.
2) Take Healthy protein XXXXXXX diet (Milk/Meat/Fish/Pulses/Beans/Nuts/Dals etc.) with extra 350 Kcal/day than usual and eat leafy vegetables & fresh fruits.
3) Drink lots of fluid/water to stay hydrated & for better feto-placental circulation.
4) Take an adequate bed rest and preferably 8-10 hrs daily in divided schedule.
5) Maintain personal hygiene including breast & genital care with proper washing.
6) Try to avoid stress/tension/emotional upset by regular XXXXXXX breathing.
7) Certain things should be avoided like any type of sexual activity/ intercourse, long journey/stepping uneven surface and high heel shoe (risk of fall on ground with miscarriage) etc.
8) Do periodic check up as per schedule. Repeat scan is needed in later month to assess growth & development of fetus.
9) Take Iron/calcium supplements from 16 weeks onwards, Two doses of TT in the 2nd trimester and complete all necessary investigations.
10) Periodic measurement of Weight gain and blood pressure. 10-12 kg weight gain is normal in pregnancy period.

Hope I have answered your query. If you have any further questions I will be happy to help.
Wish her good health and successful motherhood.

Regards,
Dr Soumen.
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. S Patra 1 hour later
Hello Sir,

Thanks for the wishes and also thanks a ton for such a detailed reply. I couldn't have find any such detailed reply to all my queries any where else.

Thanks for advocating again.

Regards,
XXXXXXX
doctor
Answered by Dr. S Patra 9 minutes later
Hello XXXXXXX

You are most welcome in XXXXXXX

If you do not have any clarifications, you can close the discussion and rate the answer.

Take care of her.

Regards,
Dr Soumen
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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