Disturbances of system of a hemostasis and a steady anemia.

[amys]

Good afternoon! Very much I ask to help or assist to understand with analyses.

Situation following:

There is a second pregnancy, 22 ned.

The first pregnancy has ended with destruction of a fetus in 15 weeks, the reasons - a hypercoagulation, FPN, giperandrogenija, mutation MTHFR C677T.

For current pregnancy prepared in view of the given reasons, became pregnant on trombo-a??N 50 mg.

In the first trimester ALL parameters of a hemostasis and OAK were in norm or rate.

The second trimester: D- 1,17 (norm or rate *lt; 0,5)

Calcium clotting time of plasma - 334 (180-250)

ACHTV - 17 (20-40)

AVR - (60-70)

trombinovoe time - 13 (16-21),

Prothrombin time - norm or rate

Fibrinogen - 5,19 (2-4).

Functions of thrombocytes (ADF, an adrenaline, Ristomycinum) - norm or rate

RKMF - norm or rate

By results of analyses the dosage tromboassa has been increased up to 100 mg, treatment proceeded month.

After treatment was peresdan OAK.

Results:

PLT - 438 (160-350)

PCT, MPV, PDW, WBC - norm or rate

LYMPH, GRAN - norm or rate.

RBC - 3.48 (4-5.5)

HCT - 28.7 (36-48)

MCV - norm or rate

RDW - 9.8 (12-15)

HGB - 109 (120-165)

MCH - norm or rate

MCHC - 381 (320-360).

Monocytes - 8 (3-11)

Eosinocytes - 1 (0,5 - 5)

Band neutrophils - 8 (1-6)

Segmented neutrophils - 62 (47-72)

soe - 32 (2-15)



On the basis of the given analysis of a blood the doctor has told or said that tromboass does not operate or work, as -in thrombocytes simply frightens, and has appointed or nominated fraksiparin 0,3 - 10 days, then - peresdacha a hemostasis. Whether such purpose or appointment is justified? In fact other parameters trombotsitarnogo a part in norm or rate?



Besides the question on an anemia which, despite of constant reception of iron (Maltofer), does not disappear interests: the hemoglobin remains at a level 98-108 within 10 weeks. Besides on/O to the analysis of the blood which have been handed over in 10 days after cancelling Maltofera, the maintenance or contents of iron in a blood is raised or increased: 30,5 at norm or rate 8,6-27,2. Whether reception of iron is justified in this case? Whether it is possible to assume other version of an anemia under analyses? Whether the anemia can be connected with disturbances in system of a hemostasis? What not by way of also it can be still necessary to make what that dopolintelnye analyses, for statement of the diagnosis and tactics of treatment?

Help or Assist to understand

[hips]

Criteria of an anemia at pregnant women - depression of a level of a hemoglobin below 110 g/l, a hematocrit below 33-34 %. The reason of an anemia is established or installed on the basis of a color parameter, quantity or amount of reticulocytes, a bilirubin, an osmotic resistance of erythrocytes, reaction Kumbsa, iron or gland of Serum, etc. parameters. Internal consultation of a hematologist is necessary. As it is necessary to be surveyed at a hematologist for specification of the reason of a thrombocytosis (augmentation of thrombocytes). He happens both independent disease, and display of any another.

The reason nevynashivanija pregnancy can be giperandrogenija. Consultation of the gynecologist-endocrinologist and correction of this status is necessary.

[amys]

Thanks for the answer!

I shall address once again with a question. Peresdala a coagulogram in 24 weeks, results:

AVR, ACHTV, a fibrinolysis - norm or rate.

Fibrinogen - 4,33 (norm or rate 2-4)

Prothrombin complex, trombinovoe time, MNO - norm or rate.

The ethanol test - positive (in norm or rate - otrits.)

RKMF - 5,5 (norm or rate up to 4).

Whether it is possible to assume on the basis of it or this development of the IDCS?

[malvina]

At the moment of delivery of the analysis the IDCS at you is absent.

Yours faithfully.

[hips]

Parameters of a blood at normally proceeding pregnancy in II-III a trimester

Fibrinogen, 2,6 - 5,6 g/l

RFMK up to 5,1 mg/100 ml

[hips]

RFMK-the parameter of intensity of intravascular coagulation of a blood, probably false overestimate of results of the test or dough, the reason of rising RFMK are defined or determined by the attending physician.

[Dr. Vad]

As a rule at mutation MTHFR C677T it is appointed or nominated folic in a dose of 1-2 mg day for depression of risk of an abortion and prof- defects of a bookmark of a nervous tube at a fetus. Thrombocytes up to 500 - not a problem. Rising of iron above norm or rate can indirectly testify to the raised or increased need or requirement and carries. zhelezodefitsite (rising a transferrin or OZHSS - means i.e. at iron or gland 30 in view of what koeff. SZH/OZHSS 30-35 % OZHSS too it is raised or increased 80-90).