Normal pregnancy and antenatal care: anaemia: 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 · Normal pregnancy and antenatal care: anaemia

Sample item

A woman at 20 weeks has haemoglobin 9.5 g/dL, MCV 62 fL, a normal red cell distribution width and a normal serum ferritin. Oral iron for six weeks produced no rise in haemoglobin. What is the next best step?

APeripheral smear for malarial parasites onlyBBone marrow aspirationCIncrease to intravenous iron sucroseDHaemoglobin HPLC of the woman and, if abnormal, of her husband

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

The answer and the reasoning

D. Haemoglobin HPLC of the woman and, if abnormal, of her husband

Microcytosis with normal ferritin and a narrow red cell distribution width, unresponsive to iron, suggests beta thalassaemia trait. The HbA2 level is raised on HPLC, and screening the partner allows counselling and prenatal diagnosis if both are carriers.

Option by option

A. Peripheral smear for malarial parasites only
Malaria can cause anaemia but not a persistently low MCV with normal ferritin.
B. Bone marrow aspiration
Marrow examination is invasive and unnecessary for a likely carrier state.
C. Increase to intravenous iron sucrose
Iron stores are already normal, so more iron, even intravenous, will not help.
D. Haemoglobin HPLC of the woman and, if abnormal, of her husband (correct)
Correct. Thalassaemia trait is likely and the partner must be screened to assess fetal risk.

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.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Haemoglobin HPLC of the woman and, if abnormal, of her husband. Microcytosis with normal ferritin and a narrow red cell distribution width, unresponsive to iron, suggests beta thalassaemia trait.

Why is "Peripheral smear for malarial parasites only" not the answer?

Malaria can cause anaemia but not a persistently low MCV with normal ferritin.

Why is "Bone marrow aspiration" not the answer?

Marrow examination is invasive and unnecessary for a likely carrier state.

Why is "Increase to intravenous iron sucrose" not the answer?

Iron stores are already normal, so more iron, even intravenous, will not help.

What concept does this question test?

It tests Normal pregnancy and antenatal care: anaemia in OBG. The HbA2 level is raised on HPLC, and screening the partner allows counselling and prenatal diagnosis if both are carriers.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Normal pregnancy and antenatal care: anaemia?

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.