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Thực hành xử lý sản khoa - Trường hợp 10

Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 10', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 31 A 29-year-old woman G2 PI at 28 weeks gestation complains of fatigue of I-week duration. Her antenatal history is unremarkable except for a urinary tract infection treated with an antibiotic 2 weeks ago. The patient also states that she has had dark-colored urine over the past week. On examination her BP is 100 60 HR 80 bpm and she is afebrile rhe thyroid gland appears normal on palpation. The heart and lung examinations are unremarkable. The fundal height is 28 cm. The fetal heart tones are in the 140 to 150 bpm range. Her hemoglobin level is 7.0 g dL. What is the most likely diagnosis What is the underlying mechanism 260 CASE EILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 31 ANEMIA IN PREGNANCY HEMOLYTIC Summary A 29-year-old woman G2 Pl at 28 weeks gestation complains of fatigue of 1-week duration. She took an antibiotic for a urinary tract infection 2 weeks ago after which she noted dark-colored urine. On examination her BP is 100 60 HR 80 bpm and temperature is normal. Her hemoglobin level is 7.0 g dL. Most likely diagnosis Hemolysis due to glucose-6-phosphate dehydrogenase deficiency Underlying mechanism Nitrofurantoin-induced hemolysis due to increased fragility of the erythrocytes. Analysis Objectives 1. Know that dark-colored urine and anemia are probably caused by hemolysis. 2. Understand that some medications may be associated with hemolysis. 3. Know some of the common causes of anemia in pregnancy. Considerations This 29-year-old woman at 28 weeks gestation complains of fatigue. She took an antibiotic for a urinary tract infection and then developed dark-colored urine. She was also probably icteric. Currently her hemoglobin level is low reflecting an anemia. This constellation of symptoms likely reflects a hemolytic process. The dark urine suggests biliru-binuria. Other causes of hemolysis could include malaria HELLP hemolysis elevated liver enzymes low platelets syndrome autoimmune hemolytic anemia or sickle cell crisis. In this case the .