Intestinal malabsorption in megaloblastic pregnancy anaemia

A pregnant woman with severe epistaxis--a rare manifestation of folic acid deficiency

The case-history of a pregnant woman with a life-threatening thrombocytopenia, due to folic acid deficiency, caused by an extremely low dietary intake is described. As folic acid deficiency manifests itself in a variety of ways, its clinical features are not always easily recognized. Timely recognition is important because of the rapid progressive nature of the disorder, especially in pregnancy, and because rapid improvement is achieved by simple treatment: supplementation of the deficiency. This is well illustrated in the patient described in this case report. A short review of the literature is presented.

Coeliac disease. Reappraisal of clinical diagnosis

Twelve children previously diagnosed as having coeliac disease on criteria now regarded as incomplete have been reinvestigated. Six were found to have an intestinal mucosal lesion characteristic of coeliac disease. All but one had been asymptomatic on a normal diet for more than 18 months. Response to diet fails to distinguish between coeliacs and non-coeliacs. Establishing the diagnosis of coeliac disease by intestinal biopsy is essential, since even apparently symptomless individuals are at considerable risk.