Hypertensive disorders: methyldopa haemolysis: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Hypertensive disorders: methyldopa haemolysis

Sample item

A pregnant woman on methyldopa for chronic hypertension becomes tired, pale and mildly jaundiced. The direct Coombs test is positive. What is the best explanation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Drug-induced autoimmune haemolytic anaemia

Methyldopa can induce red-cell autoantibodies, giving a positive direct Coombs test and haemolysis, and it may also cause hepatitis and depression. The drug is stopped and an alternative such as labetalol or nifedipine is used.

Option by option

  • A. Microangiopathic haemolysis of HELLP syndrome

    HELLP haemolysis is microangiopathic and the Coombs test is negative.

  • B. Drug-induced autoimmune haemolytic anaemia (correct)

    Correct. A positive direct Coombs test on methyldopa indicates immune haemolysis.

  • C. Megaloblastic anaemia from folate deficiency

    Folate deficiency causes macrocytic anaemia and does not produce a positive Coombs test.

  • D. Physiological haemodilution of pregnancy

    Physiological haemodilution does not cause jaundice or a positive Coombs test.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Drug-induced autoimmune haemolytic anaemia. Methyldopa can induce red-cell autoantibodies, giving a positive direct Coombs test and haemolysis, and it may also cause hepatitis and depression.

Why is "Microangiopathic haemolysis of HELLP syndrome" not the answer?

HELLP haemolysis is microangiopathic and the Coombs test is negative.

Why is "Megaloblastic anaemia from folate deficiency" not the answer?

Folate deficiency causes macrocytic anaemia and does not produce a positive Coombs test.

Why is "Physiological haemodilution of pregnancy" not the answer?

Physiological haemodilution does not cause jaundice or a positive Coombs test.

What concept does this question test?

It tests Hypertensive disorders: methyldopa haemolysis in OBG. The drug is stopped and an alternative such as labetalol or nifedipine is used.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hypertensive disorders: methyldopa haemolysis?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.