A 26-year-old primigravida at 32 weeks gestation has hemoglobin 10.6 g/dL, MCV 84 fL, serum ferritin 38 ng/mL, and normal reticulocyte count. She has no symptoms. What is the most likely explanation?

• A Iron deficiency anemia
• B Beta-thalassemia minor
• C Folate deficiency anemia
• D Physiological anemia of pregnancy ✓

Explanation

Plasma volume increases by 40-50% in pregnancy, peaking at 28-32 weeks, causing hemodilution and lowering hemoglobin to 10-11 g/dL. Normal MCV and normal ferritin exclude iron deficiency and thalassemia. Folate deficiency produces macrocytosis. This pattern is physiological, not pathological, and requires no treatment beyond routine antenatal iron and folic acid supplementation.

Reference: Williams Obstetrics, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.