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What causes drop in hemoglobin level?

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AL-Kateb
AL-Kateb

My wife is pregnant, she did a test two months ago for hemoglobin, her hemoglobin level was 10 back then, her doctor prescribed some supplements that had a bunch of minerals and vitamins including iron, as well as calcium, she is in her 32nd week now, she did the test again and her hemoglobin level dropped to 7.7 despite all the supplements that she is taking, there is no internal hemorrhage as far as the tests can show, so is there an issue other than vitamin or iron deficiencies that might explain the drop in hemoglobin? When is a blood transfusion required? Or is it safe to have a blood transfusion as a precaution?

P.S: She has vulvar varicosities

So any insight? Thanks.

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