29 June 2011 (Wednesday) - Just the Hb... (!)

This morning a midwife phoned for the result of a blood count. “Just the Hb” she chirpily announced.

GREEN, TERESA                                   AB+      Queue
DOB  25/09/1987 Sex F Pat No 123456       Received  09:40
Address   IN A TENT                                 29/06/2011
Specimen No : AW268935F    (Haematology)      

24/06/2011 00:00  EDTA
  Haemoglobin               10.9           g/dl         (    11 to 15    )
  White Blood Cells         8.7            10^9/l       (     4 to 11    )
  Platelets                 412            10^9/l       (   150 to 400   )
  Red Blood Cells           4.97           10^12/l      (   3.8 to 4.8   )
  Haematocrit               0.370          ratio        (  0.36 to 0.46  )
  Mean Cell Volume          73.4           fl           (    80 to 100   )
  Mean Cell Haemoglobin     21.9           pg           (    27 to 32    )
  Mean Cell Haemoglobin Con 29.9           g/dl         (    32 to 36    )
  Neutrophils               6.3            10^9/l       (     2 to 7.5   )
  Lymphocytes               1.9            10^9/l       (   1.5 to 4     )
  Monocytes                 0.4            10^9/l       (   0.2 to 1     )
  Eosinophils               0.1            10^9/l       (  0.02 to 0.5   )
  Basophils                 0.0            10^9/l       (     0 to 0.1   )
  XE FLAG1                  Iron deficiency ?                             
  XE FLAG2                  ^A blood film has been reviewed               


A haemoglobin of 10.9 isn’t entirely unexpected in an ante-natal case. But an MCV of 73.4 is indicative of incipient iron deficiency. So I gave her the Hb and the MCV. I could tell from the tone of voice that she had no idea why I’d read out the MCV. So I explained. “But the Hb’s normal” she said. So I explained (briefly) about iron metabolism.
So many people still feel that haemoglobin level and iron status are synonymous. They are not. I can remember having a similar conversation with a midwife when my son (now aged twenty three) was at the ante-natal stage. It would seem that some things never change.
It’s just as well that there’s the likes of me available to advise…..

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