She had a history of chronic blood loss diseases such as menorrhagia; a history of long-term partial eclipse, vomiting in early pregnancy, and malnutrition caused by gastrointestinal disorders.

In mild cases, there are no obvious symptoms, or only the skin, lip mucosa, and palpebral conjunctiva are slightly pale; in severe cases, fatigue, dizziness, palpitation, shortness of breath, lack of appetite, abdominal distension, diarrhea, pale skin and mucous membranes, dry skin and hair, brittle nails, and oral cavity inflammation, glossitis, etc.

Hemoglobin <110g/l., hematocrit <0.30; peripheral blood smear red blood cells showed low pigment and small cells.

Serum iron <6. 5umol/L (3.5ug/dl).

The ferritin decrease is less than 10ng/ml.

Bone marrow: The red blood cell system proliferates actively, mainly medium and late immature red blood cells. Red blood cell divisions are visible, and no stainable iron is seen.

Parturients with severe anemia should have blood matched for later use.

Closely monitor the labor process to prevent it from being too long. Vaginal delivery can shorten the second stage of labor, but birth trauma should be avoided.

Actively prevent postpartum hemorrhage.

If bleeding is severe, blood transfusion should be done promptly.

Strict aseptic operation is performed during labor, and broad-spectrum antibiotics are used to prevent infection during and after delivery.

anemia

gastrointestinal symptoms

peripheral neuritis symptoms

other

The blood pictures of folic acid and vitamin B12 deficiencies are the same. Hb is often lower than 40g~60g/L, accompanied by thrombocytopenia and leukopenia.

The peripheral blood smear showed macrocytic anemia, mean red blood cell volume (MCV)>100fl, and mean hemoglobin content (MCH)>32pg. Neutrophils are too lobed, with more than 5 leaves.

Bone marrow appearance: megaloblastic red blood cell proliferation >10%, large red blood cells, and loose nuclear chromatin. The granulocyte system and megakaryocytic system also undergo megamorphosis.

If serum folic acid is measured <6.8mmol/L (3ng/ml) and red blood cell folic acid is <227mmol/L (100ng/ml), it can be determined to be folic acid deficiency anemia; if serum vitamin B12 is measured <90pg/ml, it can be determined to be vitamin B12 deficiency. .

Severe anemia is often accompanied by bleeding tendencies. The bleeding lesions are mostly limited to the skin and mucous membranes. In severe cases, subarachnoid hemorrhage or intracranial hemorrhage may occur.

Common infections

Peripheral blood picture: pancytopenia, decreased reticulocytes.

Bone marrow picture: Bone marrow hematopoietic function is significantly reduced.

therapeutic abortion

supportive care

Glucocorticoid therapy

Prevent infection

Try to deliver vaginally as much as possible to shorten the second stage of labor and prevent excessive force in the second stage of labor, which may cause bleeding in important organs such as the brain or intracranial hemorrhage in the fetus. Appropriate midwifery is possible, but birth trauma must be avoided. After delivery, carefully check the soft birth canal and carefully suture the wound to prevent the formation of birth canal hematoma. For those with indications for obstetric surgery, it is advisable to remove the uterus during cesarean section to avoid postpartum hemorrhage and puerperal infection.

Continue supportive therapy, use uterotonics to strengthen uterine contractions, prevent postpartum hemorrhage, and use broad-spectrum antibiotics to prevent infection.