Aims and objectives: Early diagnosis and management of a case of B12 and folic acid deficiency, as there is no gold standard protocol for diagnosis of this type of anemia.
Case report: A 24 years G2P1L1A0 with 32 weeks gestation presented with: Hb: 3 g%, red blood cells (RBCs: 1700 cells/ mm3, white blood cells (WBCs): 2700 cells/mm3, platelets: 80000 cells/mm3.
Ultrasound is suggestive of single live intrauterine pregnancy of 32.4 weeks, with cephalic presentation with symmetrical intrauterine growth restriction, amniotic fluid index (AFI): 7–8 cm. Obstetric Doppler suggestive of increased SD ratio in umbilical artery, reduced periodontal index (PI) in the right uterine artery.
Patient treated with 3 units of packed cell colume (PCV) with 3 doses of intravenous B12 and vitamin C injections followed by oral iron, oral B12, and folic acid.
Patient advised follow-up after 15 days.
Reports after 15 days:
Hb: 8.6 g%, RBCs: 3.07 x 1012/L, WBCs: 10.2 x 109/L, Pletlets: 33.2 x 109/L
Ultrasound is suggestive of single live intrauterine pregnancy of 33.3 weeks gestation with cephalic presentation, AFI: 8–9 cm.
Obstetric Doppler: No significant abnormality in obstetric Doppler indices in the present scan.
Conclusion: Early intervention and diagnosis of megaloblastic anemia in late pregnancy reduce significant maternal and fetal morbidity and mortality.
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