Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 129

The recommended laboratory evaluation for normocytic anemia is displayed in Figure 11.2. A high reticulocyte count indicates either hemolysis or blood loss with resultant bone marrow activation. If a normocytic anemia with an elevated reticulocyte count is found, a careful history and evaluation of laboratory studies for hemolysis, such as Coombs test, peripheral smear, and lactate dehydrogenase level, should be undertaken. A normal or low reticulocyte count in the setting of anemia raises concern for iron deficiency (a ferritin level less than 10–15 μg/dL is diagnostic) or bone marrow suppression/disorders. Low reticulocyte count with normal or high serum ferritin levels can be seen in the presence of hypothyroidism or chronic disorders, such as inflammatory bowel disease, systemic lupus erythematosus, granulomatous infections, malignant neoplasms, and rheumatoid arthritis. Hematology consultation for further assessment is indicated in these circumstances.

Figure 11.2 Algorithm for evaluation of normocytic anemia.

Mixed nutritional deficiencies (folate and iron) may lead to normocytic anemia in pregnancy, but routine supplementation makes the probability of such a scenario low. If concern for a mixed nutritional deficiency does arise, the red cell distribution width (RDW), a marker of increased variability in red cell size or anisocytosis, is a useful indicator as an RDW greater than 15% indicates the presence of nutritional deficiencies.