Anaemia - Data Interpretation

Question 1

An 84y/o woman presents with :

Hb 63 (108-143)
MCV 123 (82-99) 
WBC 3.2 (4-10) 
Plts 90 (140-400)

Oval and pale macrocytes on blood film

What is the likely diagnosis of: - explain your choice

A) Iron deficiency anaemia
B) Megaloblastic anaemia
C) Acute leukaemia
D) Chronic anaemia secondary to diabetes

Answer 1

B) Megaloblastic anaemia
Diabetes anaemia unlikely

Iron deficiency would likely be microcytic

Question 2

How would you confirm a diagnosis of macrocytic anaemia?

A)Plasma G-6-PD levels

B)Serum Ferritin level

C)Serum B12 and folate levels

D)Reticulocyte count, bilirubin and LDH

Answer 2

C)Serum B12 and folate levels

Question 3

What is the diagnostic test for pernicious anaemia?

Answer 3

Anti-intrinsic factor antibody test

Question 4

What is the treatment for pernicious anaemia?

Answer 4

Intramuscular vitamin B12

Question 5

A 22 year old student presents as Tired, irritable, low concentration, breathlessness and pallor.

Her FBC and blood film is as follows:

Hb 84 (120-160)
MCV 77 (82-99)
MCH 23 (27-32) 
WBC 5.7 (4-10) 
Plts 434 (140-400)

What is the name of this anaemia? What test would you do first?

Answer 5

Hypochromic, microcytic anaemia

Serum ferritin

Question 6

What questions would you ask a patient with iron deficiency anaemia?

Answer 6

Bleeding

Menorrhagia

Pregnancy

Diet

GI symptoms

Question 7

When should an iron deficiency patient be referred for GI investigations?

Answer 7

With co-morbid GI symptoms

Question 8

What of the following is a possible cause of hypochromic, microcytic anaemia with normal ferritin?

A.Hereditary spherocytosis

B.G6PD deficiency

C.Sickle cell anaemia

D.Thalassaemia trait

Answer 8

Thalassaemia (trait)

Question 9

How does Secondary anaemia/anaemia of chronic disease present?

Answer 9

Normochromic, normocytic anaemia

Normal/elevated ferritin

Question 10

34 year old waiter presents: Tired, yellow eyes

Hb73 (140-180)

MCV 98 (82-99)

MCH 32 (27-32)

WCC 7.2 (4-10)

Plts 480 (140-400)

Patient has spherocytes on blood film, what investigations should be ordered and why?

Answer 10

Reticulocyte count - bone marrow function

Serum haptoglobin - low in haemolysis

Bilirubin/LDH - elevated in haemolysis

DAGT/Coombs test - Positive in (auto)immune haemolysis

Question 11

What blood tests should be ordered when sickle cells are seen on blood film?

Answer 11

Reticulocyte count

Bilirubin, LD

Haemoglobinopathy screen (confirms Dx)

Question 12

A 34 year old waiter with sickle cell disease presents with pain on upper left quadrant of abdomen, which of the following is the least likely cause and why?

A)Bony crisis

B)Pneumonia

C)Pulmonary Embolism

D)Splenic infarction

Answer 12

A)Bony Crisis

Patient is an adult, sickle cell disease means this patient’s spleen would have degenerated as an infant due to infarction

Question 13

How does Chest crisis present in sickle cell?

Answer 13

Worsening hypoxia

Fever

Chest pain

Infiltrates on CXR