Treatment of an anemia

[Soto]

I wish to consult.

Situation. The woman of 26 years. 2 pregnancy. The hypothyrosis - accepts a L-thyroxine of 125 mg (last TTG from 05.12.2005 - 0,37). A delivery good - morning of a porridge, cottage cheese, a dinner and a supper meat dishes (basically pork, a beef), enough of fruit. Complaints: a xeroderma, periodically day time sleepiness, delicacy, a chair with the tendency to constipations.

MT - 58 kg.

OAK (last from 01.12.2005):

WBC - 11.2 RBC - 3.42 HGB - 10.3 PLT - 311 MCV - 85 MCH - 30.1 MCHC - 35.2 CENTRAL PROCESSING UNITS - 0,9 macrocytes + 1 3 65 24 7 an ESR 30

gr.kr. B (III) Rh +

/O (from 05.12.2005) ZHS - 7,8 OZHSS - 88

From the previous analyses:

Low level of a hemoglobin constant within at least 3 years - at a level 103 - 112

In/O a constant hyperbilirubinemia at a level 25-28 due to indirect

Level of thrombocytes in former OAK - 190, 199.



Pregnancy the second, the first 2002-2003. There was an attempt of treatment of an anemia during 1 pregnancy in 2 trimester - the preparation gino- 4 weeks was accepted, then ferrum- 2 weeks - the level of a hemoglobin did not vary, because of the developed constipations reception of iron preparations has been stopped.



I ask to consult on following questions:

1 - whether rights I, meaning an iron deficiency anemia?

2 - what it is better to use iron preparations? Sorbifer?

3 - how to spend the control of treatment? - OAK ch/? 3-4 weeks, then monthly? When to repeat ZHS and OZHSS. There is an opportunity to define or determine a ferritin (but only at the following control of a venous blood, together with TTG).

4 - how to reduce to a minimum by-effects of reception of iron preparations.

[Dr.]

1 - Here not all is pleasant... Especially - normotsitarnaja an anemia, with any macrocytes, absence of reaction to iron preparations, whether the indirect bilirubin, etc. can be B12+ anemias? If the hypothyrosis has always been compensated, hardly he would give such anemia. Whether can be -induced? What medicines accepts constantly, than still is ill or sick? What in old analyses and what reticulocytes were and is?

[Soto]

1 - Here not all is pleasant...

And not all is pleasant to me... Never smotreny, under old analyses only a hemoglobin, erythrocytes and the CENTRAL PROCESSING UNIT it is possible to look or see reticulocytes. Only the L-thyroxine constantly is accepted. From 13.11 till there was a hospitalization - acute gestatsionnyj a pyelonephritis at the left, a serous phase. hr.gipohromnaja an anemia (it is the discharge diagnosis, the situation was discussed with hospitalization at a forum earlier). In a hospital received infusional therapy, tsefatoksim in/m, Nospanum. Other diseases are not present.

[Dr.]

And not all is pleasant to me... Never smotreny, under old analyses only a hemoglobin, erythrocytes and the CENTRAL PROCESSING UNIT it is possible to look or see reticulocytes. Only the L-thyroxine constantly is accepted. From 13.11 till there was a hospitalization - acute gestatsionnyj a pyelonephritis at the left, a serous phase. hr.gipohromnaja an anemia (it is the discharge diagnosis, the situation was discussed with hospitalization at a forum earlier). In a hospital received infusional therapy, tsefatoksim in/m, Nospanum. Other diseases are not present.



To one analysis with MCV, but without reticulocytes to trust I do not wish:). In parallel - the anamnesis, i.e. that with monthly also that with GASTROINTESTINAL TRACT, whether is lost okuda a blood. Urologists for certain would do or make and quite could hook there LDG, whether are not present? It in fact your wife? Can, entrust treatment to someone, and that the somehow not so.



P.S. About iron preparations - who absolutely Zinci sulfas does not transfer or carry, is maltofer. To sorbiferu all the same it is necessary to add askorbinku, there it or her a little. And to accept correctly, coffee to not wash down, etc.:). But it is necessary to understand all over again