A 24-year-old primigravida at 14 weeks has haemoglobin 10.2 g/dL, MCV 68 fL, serum ferritin 45 ng/mL and transferrin saturation 30%. Oral iron has not been started. What is the MOST appropriate next step?

• A Start oral ferrous sulfate empirically and recheck haemoglobin in 4 weeks
• B Repeat full blood count at 28 weeks only
• C Give intravenous iron sucrose
• D Perform haemoglobin electrophoresis with HbA2 estimation ✓

Explanation

Microcytosis with normal iron stores points away from iron deficiency towards a thalassaemia trait, and confirmation requires haemoglobin electrophoresis showing raised HbA2 above 3.5 percent in beta thalassaemia trait. Starting iron empirically would mask the diagnosis and delay partner screening, which matters because if the husband is also a carrier there is a 25 percent risk of thalassaemia major. Intravenous iron is reserved for proven iron deficiency that fails oral therapy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.