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Suggest Treatment For Sickle Cell Trait With Severe Anemia
Question: G2P1L1 with 27+6 weeks twin gestation today with K/c/o Sickle cell trait with severe anemia admitted on 9/5/14 with c/o breathlessness ,weakness and fatigue
Investigations :
9/5/14
HB â 4.7 g/dl , PCV â 16.2,
MCV-53.1,MCH-15.4,MCHC-29,RDW-22.7,
TLC-9700,PLT-3.10Lacs ,
Urine routine -2-3 pus cells
Sr Iron -13.8,TIBC-524 ,%Saturation 2.63,
Ferritin-2.37,VIT B12-271
T Bili-0.6 Direct-0.1 Indirect-0.5 ,LDH-487
10/5/14 Post 1PRBc-HB-6.1,TLC-12800,PLT-2.52 lacs
Reference to Dr XXXXXXX Bakshi (hemato oncologist done )
Adviced :Reticulocyte count ,LDH , Bilirubin direct and indirect
ONE unit PRBCs on 9/5/14 two units on 10/5/14
Tab folic acid 5 mg 1-0-0,
Target Hb-10to 11 g/dl.
9/5/14 Usg done by Dr XXXXXXX Vazirani
Provisional report : DCDA Twin
Fetus A- cephalic ,LIQUOR ânormal SLP-7.8 cms , EFW- 983g
Fetus B- cephalic , liquor ânormal SLP- 4.8, EFW- 913g, fall in growth SGA
CERVIX SHORT INCOMPETENT 1.2 cms
Doppler :fetus B â High resistance flow in umbilical artery , normal flow in MCA
Inj Steroid ,Proluton given .
2 units PRBCs are to be given today .
Investigations :
9/5/14
HB â 4.7 g/dl , PCV â 16.2,
MCV-53.1,MCH-15.4,MCHC-29,RDW-22.7,
TLC-9700,PLT-3.10Lacs ,
Urine routine -2-3 pus cells
Sr Iron -13.8,TIBC-524 ,%Saturation 2.63,
Ferritin-2.37,VIT B12-271
T Bili-0.6 Direct-0.1 Indirect-0.5 ,LDH-487
10/5/14 Post 1PRBc-HB-6.1,TLC-12800,PLT-2.52 lacs
Reference to Dr XXXXXXX Bakshi (hemato oncologist done )
Adviced :Reticulocyte count ,LDH , Bilirubin direct and indirect
ONE unit PRBCs on 9/5/14 two units on 10/5/14
Tab folic acid 5 mg 1-0-0,
Target Hb-10to 11 g/dl.
9/5/14 Usg done by Dr XXXXXXX Vazirani
Provisional report : DCDA Twin
Fetus A- cephalic ,LIQUOR ânormal SLP-7.8 cms , EFW- 983g
Fetus B- cephalic , liquor ânormal SLP- 4.8, EFW- 913g, fall in growth SGA
CERVIX SHORT INCOMPETENT 1.2 cms
Doppler :fetus B â High resistance flow in umbilical artery , normal flow in MCA
Inj Steroid ,Proluton given .
2 units PRBCs are to be given today .
Brief Answer:
The treatment given is correct
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
The treatment given is correct as sickle cell anemia with Hb 4.7 will need blood transfusion.
Also steroids are needed to reduce the damage by the sickle cells on blood vessels.
A short cervix will need a cervical stitch to prevent miscarriage.
The doppler needs to be repeated every 4 -5 days to see changes.
Her weakness and breathlessness will go once she gets blood transfusion.
Feel free to consult me directly
http://bit.ly/drsombiswas
Regards
Dr. Som Biswas M.D.
Mumbai
The treatment given is correct
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
The treatment given is correct as sickle cell anemia with Hb 4.7 will need blood transfusion.
Also steroids are needed to reduce the damage by the sickle cells on blood vessels.
A short cervix will need a cervical stitch to prevent miscarriage.
The doppler needs to be repeated every 4 -5 days to see changes.
Her weakness and breathlessness will go once she gets blood transfusion.
Feel free to consult me directly
http://bit.ly/drsombiswas
Regards
Dr. Som Biswas M.D.
Mumbai
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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