A 24-year-old primigravida at 30 weeks has haemoglobin 8.5 g/dL, MCV 108 fL, and peripheral smear showing hypersegmented neutrophils and oval macrocytes. Serum vitamin B12 level is normal. Which is the most likely cause of her anaemia?
- A Folate deficiency ✓
- B Pernicious anaemia
- C Hypothyroidism
- D Myelodysplastic syndrome
Correct answer: A. Folate deficiency
Explanation
Megaloblastic anaemia in pregnancy is almost always due to folate deficiency, because fetal demands raise the daily folate requirement several fold and dietary intake often falls short. The normal B12 level rules out pernicious anaemia, which anyway is rare in women of reproductive age. Hypothyroidism causes a normocytic or macrocytic anaemia without hypersegmented neutrophils, and myelodysplasia is a disease of older adults. Hypersegmented neutrophils are the earliest morphological marker of megaloblastosis.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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