Which hematological finding for a pregnant woman requires immediate referral for further evaluation?
a. increased white blood cell (WBC) and red blood cell (RBC) volume
b. increased fibrinogen and clotting factors VII through X
c. low platelets, hemolysis, and elevated liver enzymes
d. increased plasma volume and decreased hematocrit
C
Failure of the normal physiological anemia of pregnancy to occur in the third trimester may be associated with hypertensive disorders of pregnancy (HDP). Complications of HDP may include the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). The HELLP syndrome can result in placental abruption, acute renal failure, hepatic rupture, and fetal and maternal death. Immediately refer patients with these symptoms for further evaluation. Increased white blood cell (WBC) count, increased total red blood cell (RBC) volume, increased fibrinogen and clotting factors VII through X, increased plasma volume, and decreased hematocrit are normal findings.
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