Blackboard EMQs Haematology Flashcards

1
Q

A 62 year old woman with RA is taking methotrexate, prednisolone and ibuprofen. She is admitted to A&E with the sudden onset of weakness and faintness. She feels nauseated and is hypotensive. Hb is 8g/dl.

What is the most likely diagnosis?
A. Dietary folic acid deficiency
B. Pernicious anaemia
C. Sickle cell anaemia
D. Blood loss
E. Coeliac disease
F. Iron deficiency
G. Thalassaemia major
H. Sickle cell trait
I. Anaemia of chronic disease
J. Haemolytic uraemic syndrome
K. Glucose-6-phosphate dehydrogenase deficiency
L. Hereditary
A

D. Blood loss

This is blood loss from a bleeding peptic ulcer. The patient here has a key risk factor to the development of a peptic ulcer with chronic NSAID use (ibuprofen). NSAIDs inhibit COX which has the effect of reducing PGE2 levels. PGE2 plays a role in gastric cytoprotection by downregulating HCl production and increasing mucus and the production of bicarbonate. This leads to gastric irritation and ulceration. A PPI can be prescribed alongside NSAIDs or misoprostol can be used, which is a stable PGE1 analogue which mimics local PG to maintain the gastroduodenal mucosal barrier. NSAID induced ulcers are more likely to be gastric than duodenal.

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2
Q

A 17 year old Northern European Caucasian girl has a normocytic normochromic anaemia with a low ferritin, low serum B12 & low red cell folate. A Schilling test shows malabsorption of vitamin B12 which is not corrected by intrinsic factor.

What is the most likely diagnosis?
A. Dietary folic acid deficiency
B. Pernicious anaemia
C. Sickle cell anaemia
D. Blood loss
E. Coeliac disease
F. Iron deficiency
G. Thalassaemia major
H. Sickle cell trait
I. Anaemia of chronic disease
J. Haemolytic uraemic syndrome
K. Glucose-6-phosphate dehydrogenase deficiency
L. Hereditary
A

E. Coeliac disease

This is a common condition in the US and Europe. Coeliac disease most commonly presents with IDA, although it can also lead to a macrocytic anaemia with mainly folate deficiency (though B12 is also affected but hepatic stores last several years). It would be an uncommon instance in this case for all three of iron, B12 and folate to be low. However, this history and the findings point to coeliac disease. The B12 deficiency is not corrected by IF which means that the cause is malabsorption opposed to pernicious anaemia with a lack of IF. It is worth noting that the Schilling test is no longer routinely done in clinical practice. In this test, IM vitamin B12 is given to saturate stores. Then oral radiolabelled B12 is given and urine is collected over 24 hours. The amount excreted is lower in B12 malabsorption. If this is not corrected by IF the problem is with the ileum and not inadequate IF. Coeliac is an autoimmune condition triggered by gluten peptides found in wheat, rye and barley. The ultimate best test is duodenal biopsy and histology to show intra-epithelial lymphocytes, villous atrophy and crypt hyperplasia. Macroscopic changes may be present but endoscopy is generally unhelpful. The test of choice before performing such an invasive confirmatory test is to look for elevated anti-gliadin antibodies. Anti-tissue transglutaminase is less accurate and endomysial antibody is more expensive and has lower sensitivity.

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3
Q

A 32 year old pregnant West African woman has an Hb of 10.2g/dl, a normal MCV & a positive sickle solubility test. Haemoglobin electrophoresis shows 45% haemoglobin S & 55% haemoglobin A.

What is the most likely diagnosis?
A. Dietary folic acid deficiency
B. Pernicious anaemia
C. Sickle cell anaemia
D. Blood loss
E. Coeliac disease
F. Iron deficiency
G. Thalassaemia major
H. Sickle cell trait
I. Anaemia of chronic disease
J. Haemolytic uraemic syndrome
K. Glucose-6-phosphate dehydrogenase deficiency
L. Hereditary
A

H. Sickle cell trait

Africans have higher incidence of sickle cell trait and anaemia. About 8% of black people carry the gene and the prevalence is high in sub-Saharan Africa. Sickling occurs when RBCs containing HbS become distorted into a crescent shape. Sickle cell trait occurs when the child inherits a sickle gene from one parent and a normal gene from the other parent. This is shown by the eletrophoresis results. Patients with sickle cell anaemia have no HbA at all. A sickle solubility test will not be able to differentiate between sickle cell disease and sickle cell trait, and may not be accurate in young infants under 6 months due to fetal Hb. If both parents carry the sickle cell gene, there is a 1 in 4 chance of giving birth to a child with sickle cell anaemia. Sickle cell disease also includes other conditions such as HbS from one parent with another abnormal Hb or beta thalassaemia from the other parent such as HbS-Beta thal and HbSC.

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4
Q

A 66 year old alcoholic man has a firm irregular liver, testicular atrophy, splenomegaly, a normocytic normochromic anaemia & thrombocytopaenia.

What is the most likely diagnosis?
A. Dietary folic acid deficiency
B. Pernicious anaemia
C. Sickle cell anaemia
D. Blood loss
E. Coeliac disease
F. Iron deficiency
G. Thalassaemia major
H. Sickle cell trait
I. Anaemia of chronic disease
J. Haemolytic uraemic syndrome
K. Glucose-6-phosphate dehydrogenase deficiency
L. Hereditary spherocytosis
A

I. Anaemia of chronic disease

Whilst alcoholism may prompt you to consider alternative causes for this man’s anaemia, a positive alcohol history may be present in those with ACD and the normocytic normochromic anemia gives this away. ACD is caused by inflammation, which can result from various disease processes. The release of pro-inflammatory cytokines leads to a cascade producing anaemia due to decreased RBC production and shortened survival. The anaemia of ACD can also be microcytic.

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5
Q

A 46 year old Indian vegetarian man with a past history of ileal resection for Crohn’s Disease presents with an Hb of 11.6g/dl & a MCV of 110fl.

What is the most likely diagnosis?
A. Avascular necrosis
B. Gout
C. B12 malabsorption
D. Beta thalassaemia
E. Haemolytic anaemia
F. Chronic renal failure
G. IDA
H. Anaemia of chronic disease
I. Acute blood loss
J. Chronic blood loss
K. Polycythaemia rubra vera
L. Sickle cell anaemia
M. Thrombocytopenia
A

C. B12 malabsorption

The ileal resection is also a clue here as vitamin B12 is actively absorbed at the terminal ileum (along with sodium ions and bile salts). Even without post-ileocaecal resection, ileocaecal Crohn’s can itself also give B12 deficiency. Anaemia in Crohn’s can be due to chronic inflammation, chronic blood loss or the malabsorption of iron, B12 or folic acid. The anaemia here is macrocytic, which indicates one of the latter two. ACD would give a normocytic (though possible microcytic) picture and IDA from malabsorption or blood loss would be microcytic. This is hence B12 or folate and as folate malabsorption is not an option on the list and the ileal resection here is a massive pointer to B12 malabsorption.

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6
Q

A Nigerian child aged 2 presents to A&E crying with pain. On examination he is found to have swollen fingers & faint jaundice. The child’s blood count shows a WBC & neutrophil count that are higher than expected for an African child.

What is the most likely diagnosis?
A. Avascular necrosis
B. Gout
C. B12 malabsorption
D. Beta thalassaemia
E. Haemolytic anaemia
F. Chronic renal failure
G. IDA
H. Anaemia of chronic disease
I. Acute blood loss
J. Chronic blood loss
K. Polycythaemia rubra vera
L. Sickle cell anaemia
M. Thrombocytopenia
A

L. Sickle cell anaemia

Africans have a higher incidence of this condition. About 8% of black people carry the gene and the prevalence is high in sub-Saharan Africa. Sickling occurs when RBCs containing HbS become distorted into a crescent shape. Patients with sickle cell anaemia have no HbA at all. If both parents carry the sickle cell gene, there is a 1 in 4 chance of giving birth to a child with sickle cell anaemia. This patient has presented with hand-foot syndrome with swollen fingers which are painful. This is dactylitis resulting from a skeletal vaso-occlusive crisis, the presentation of which depends on age, as in older childen, marrow is more commonly found in the epiphyses and in adults is limited to the bones of the axial skeleton. The FBC should also show some degree of anaemia and leukocytosis is also a presentation in infants, the cause of which is not clear but it is suggested to be due to splenic infarction. The jaundice is an indication of haemolysis.

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7
Q

A 72 year old man presents with left hemiplegia of sudden onset. On examination, he appears plethoric & his spleen is felt 3cm below the left costal margin. He appears normally hydrated. FBC reveals:WBC 23x109/l, Hb 18.2g/dl, Platelet count 614 x109/l

What is the most likely diagnosis?
A. Avascular necrosis
B. Gout
C. B12 malabsorption
D. Beta thalassaemia
E. Haemolytic anaemia
F. Chronic renal failure
G. IDA
H. Anaemia of chronic disease
I. Acute blood loss
J. Chronic blood loss
K. Polycythaemia rubra vera
L. Sickle cell anaemia
M. Thrombocytopenia
A

K. Polycythaemia rubra vera

PRV is a disease of middle and older age and is strongly associated with the JAK2V617 mutation. Facial redness and fullness is commonly observed and splenomegaly is a common finding. Pruritis is a common feature and is often severe and evoked by contact with water. It is a myeloproliferative disorder with raised Hct, Hb and RBC count. Blood hence becomes very viscous. There is a clear link between Budd-Chiari syndrome and subsequent PRV. Treatment is with venesection. Around 30% will go on to develop myelofibrosis.

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8
Q

A 67 year old man presents to his GP complaining of lethargy & weight loss. Rectal examination revealed a palpable irregular mass in the rectum. He is found to have a microcytic anaemia.

What is the most likely diagnosis?
A. Avascular necrosis
B. Gout
C. B12 malabsorption
D. Beta thalassaemia
E. Haemolytic anaemia
F. Chronic renal failure
G. IDA
H. Anaemia of chronic disease
I. Acute blood loss
J. Chronic blood loss
K. Polycythaemia rubra vera
L. Sickle cell anaemia
M. Thrombocytopenia
A

J. Chronic blood loss

This patient has a rectal carcinoma as indicated by his symptoms combined by the palpable mass in the rectum. He is anaemic due to blood loss and this accounts for his lethargy. Treatment of rectal carcinoma involves surgical excision where possible. This can either be an anterior resection (tumours in the upper 1/3 of the rectum) or an abdominoperineal resection (if the tumour lies lower down). APER involves the formation of a permanent colostomy and has a high incidence of sexual and urinary dysfunction. Anterior resection involves a colo-anal anastamosis.

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9
Q

Philadelphia chromosome

Choose the diagnosis that matches the abnormality most closely.
A. Hodgkin's Disease
B. Multiple myeloma
C. Chronic myeloid leukaemia
D. Non-Hodgkins lymphoma
E. Acute lymphoblastic leukaemia
F. Eosinophilic leukamia
G. Polycythaemia rubra vera
H. Acute myeloid leukaemia
I. Essential thrombocythaemia
J. Chronic lymphocytic leukaemia
A

C. Chronic myeloid leukaemia

The pathognomic feature of CML is the Philadelphia chromosome, which is a reciprocal translocation between chromosomes 9 and 22 which results in an abnormal chromosome 22. The BCR gene on 22 is fused with the ABL gene from 9 resulting in the BCR-ABL fusion oncogene. BCR-ABL is an active tyrosine kinase which phosphorylates and alters the activity of downstream signal transduction proteins. Treatment is hence with a tyrosine kinase inhibitor such as imatinib which inhibits the BCR-ABL tyrosine kinase.

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10
Q

Reed Sternberg cell

Choose the diagnosis that matches the abnormality most closely.
A. Hodgkin's Disease
B. Multiple myeloma
C. Chronic myeloid leukaemia
D. Non-Hodgkins lymphoma
E. Acute lymphoblastic leukaemia
F. Eosinophilic leukamia
G. Polycythaemia rubra vera
H. Acute myeloid leukaemia
I. Essential thrombocythaemia
J. Chronic lymphocytic leukaemia
A

A. Hodgkin’s Disease

The characteristic cell of Hodgkin’s lymphoma is the Reed-Sternberg cell. These have an ‘owl’s eye’ appearance.

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11
Q

Increase of monoclonal plasma cells in the bone marrow

Choose the diagnosis that matches the abnormality most closely.
A. Hodgkin's Disease
B. Multiple myeloma
C. Chronic myeloid leukaemia
D. Non-Hodgkins lymphoma
E. Acute lymphoblastic leukaemia
F. Eosinophilic leukamia
G. Polycythaemia rubra vera
H. Acute myeloid leukaemia
I. Essential thrombocythaemia
J. Chronic lymphocytic leukaemia
A

B. Multiple myeloma

Plasma cell infiltration into the bone marrow (>10%) indicates multiple myeloma and helps to differentiate it from MGUS and solitary plasmacytoma

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12
Q

Urinary Bence -Jones protein

Choose the diagnosis that matches the abnormality most closely.
A. Hodgkin's Disease
B. Multiple myeloma
C. Chronic myeloid leukaemia
D. Non-Hodgkins lymphoma
E. Acute lymphoblastic leukaemia
F. Eosinophilic leukamia
G. Polycythaemia rubra vera
H. Acute myeloid leukaemia
I. Essential thrombocythaemia
J. Chronic lymphocytic leukaemia
A

B. Multiple Myeloma

A Bence Jones protein is an immunoglobulin light chain which is suggestive of multiple myeloma or Waldenstrom’s macroglobulinaemia.

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13
Q

A 45 year old male presents with a 4 month history of weight loss and anorexia. He complains of recently experiencing sweats and abdominal examination reveals splenomegaly. What is the likely diagnosis?

A. Smear cells
B. Schistiocytes
C. Ionising radiation.
D. Bite cells
E. Dacrocytes
F. UV radiation
G. Acute lymphoblastic leukaemia
H. Acute myeloid leukaemia
I. Chronic myeloid leukaemia
J. Magnesium
A

I. Chronic myeloid leukaemia

This is CML which tends to present in the 30-60 age group. At presentation 1/3 may be asymptomatic though if symptomatic, it presents with symptoms including fever, weight loss and night sweats. There is myeloid stem cell proliferation and presents with raised neutrophils, metamyelocytes and basophils. CML is associated with the philadelphia chromosome characterised by t(9;22) of bcr-abl. There tends to be massive splenomegaly which is the most common physical finding on examination. This conditon may transform to AML or ALL in what is known as a ‘blast crisis’. CML responds to imatinib, which is an anti-bcr-abl antibody and gives long term remission in most patients.

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14
Q

A retired 87 year old female presents with a history of repeated infections and lymphadenopathy. Which cells seen on the peripheral blood film suggest a diagnosis of chronic lymphocytic leukaemia?

A. Smear cells
B. Schistiocytes
C. Ionising radiation.
D. Bite cells
E. Dacrocytes
F. UV radiation
G. Acute lymphoblastic leukaemia
H. Acute myeloid leukaemia
I. Chronic myeloid leukaemia
J. Magnesium
A

A. Smear cells

Smear or smudge cells occur as a result of lymphocyte damage during the preparation of the slide. This is because they are fragile in CLL and so when put onto a glass slide will give rise to many broken cells.

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15
Q

A 58 year old female presents with tirednesss, leg bruises and SOB on exertion. Peripheral blood film reveals blasts containing Auer rods. The liver and spleen are not palpable.

A. Smear cells
B. Schistiocytes
C. Ionising radiation.
D. Bite cells
E. Dacrocytes
F. UV radiation
G. Acute lymphoblastic leukaemia
H. Acute myeloid leukaemia
I. Chronic myeloid leukaemia
J. Magnesium
A

H. Acute myeloid leukaemia

AML predominantly affects older adults with characteristically, abnormal blasts present in peripheral blood and normal haematopoiesis reduced. AML is basically the clonal expansion of myeloid blast cells in the bone marrow, peripheral blood or extramedullary tissue. Bone marrow blasts of at least 20% are diagnostic, obtained from BM biopsy. This patient has the features of cytopenia with signs and symptoms of anaemia and thrombocytopenia. The peripheral blood film gives away this diagnosis with myeloid blasts being present with Auer rods. While this patient does not have hepatosplenomegaly, this feature may be present.

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16
Q

A 5 year old boy presents with bone pain and lymphadenopathy. On examination he appears pale and bruised. What is the likely diagnosis?

A. Smear cells
B. Schistiocytes
C. Ionising radiation.
D. Bite cells
E. Dacrocytes
F. UV radiation
G. Acute lymphoblastic leukaemia
H. Acute myeloid leukaemia
I. Chronic myeloid leukaemia
J. Magnesium
A

G. Acute lymphoblastic leukaemia

ALL typically presents in children with bone marrow involvement and the associated symptoms. It is primarily a disease of children with 75% of all cases occuring in those under the age of 6. T-cell lineage ALL may cause mediastinal masses and associated symptoms such as stridor, wheeze and SVCO. Bone marrow infiltration leads to a pancytopenia leading to anaemia (reduced red blood cells), haemorrhage (reduced platelets) and infections (reduced mature white blood cells). In ALL, bone marrow is replaced by lymphoblasts. There may also be spread to CNS and testes. ALL is associated with Down’s syndrome. In contrast, CLL presents in older adults and is often asymptomatic, discovered by chance when a FBC is ordered. Smear/smudge cells are seen in peripheral blood smear. CLL is associated with a warm-type AIHA and there is peripheral blood lymphocytosis.

17
Q

A patient presents with acute myeloid leukaemia. Which environmental factor are they most likely to have been exposed to?

A. Smear cells
B. Schistiocytes
C. Ionising radiation.
D. Bite cells
E. Dacrocytes
F. UV radiation
G. Acute lymphoblastic leukaemia
H. Acute myeloid leukaemia
I. Chronic myeloid leukaemia
J. Magnesium
A

C. Ionising radiation.

Historically those who survived the atomic bombing of Hiroshima and Nagasaki had increased incidence of AML with a latency of 5-7 years. Radiotherapy (especially with alkylating agents like cyclophosphamide) also predisposes to AML. UV radiation is a risk factor for skin cancer

18
Q

A 60 year old man presents with bone pain (back, ribs, femur and humerus affected). Investiagtions show raised ESR, raised calcium, high urea, high creatinine and punched out lesions on his skeletal x-rays.

What is the most likely diagnosis?
A. Thalassaemia
B. Sickle Cell Anaemia
C. Pernicious Anaemia
D. Chronic Myeloid leukaemia
E. Hodgkins Lymphoma
F. Acute lymphblastic leukaemia
G. Chronic lymphocytic leukaemia
H. Iron defeciency anaemia
I. Acute myeloid leukaemia
J. Non Hodkins lymphoma
K. Myeloma
L. Haemophilia
A

K. Myeloma

This patient has multiple myeloma. This is characteristed by clonal proliferation of plasma cells in BM and commonly presents with bony pain and symptoms of anaemia. There may also be infections present in 10%. Elevated ESR agrees with this diagnosis. 30% have hypercalcaemia and half have renal impairment, which is associated with a worse prognosis. This explains the elevated urea and creatinine here. The diagnostic test is serum or urine electrophoresis looking for a paraprotein spike of IgG or IgA and light chain urinary excretion (Bence Jones proteins). Bone marrow examination and skeletal survey will also need to be conducted. Bone marrow analysis will help differentiate this from MGUS and solitary plasmacytoma. Bone changes include osteopenia, osteolytic lesions and fractures which this person’s XR indicates with the punched out lytic lesions. Younger patients may be candidates for high-dose chemotherapy and autologous transplantation.

19
Q

A 42 year old man presents with painless enlarged lymph nodes on one side of his neck. He has also noticed some recent loss of weight, fever and night sweats. He gave up drinking alcohol because it caused pain in the lymph nodes.

What is the most likely diagnosis?
A. Thalassaemia
B. Sickle Cell Anaemia
C. Pernicious Anaemia
D. Chronic Myeloid leukaemia
E. Hodgkins Lymphoma
F. Acute lymphblastic leukaemia
G. Chronic lymphocytic leukaemia
H. Iron defeciency anaemia
I. Acute myeloid leukaemia
J. Non Hodkins lymphoma
K. Myeloma
L. Haemophilia
A

E. Hodgkins Lymphoma

Hodgkin’s is localised to a single group of nodes (normally the cervical and/or supraclavicular) and extranodal involvement is rare. Mediastinal involvement is common. Spread is contiguous and B symptoms may be present such as a low grade fever, weight loss and night sweats. Pruritis may be found in approximately 10% of cases but has no prognostic significance. 50% of cases is associated with EBV infection and distribution is bimodal with peaks in young and old. There is classically pain in lymph nodes on alcohol consumption.

20
Q

A 50 year old man with a 5 month weight loss, tiredness, fever, night sweats and abdominal fullness. On examination his spleen was palpably enlarged and there were multiple bruises on his body. Investigations show low Hb and WBC 150x109/L.

What is the most likely diagnosis?
A. Thalassaemia
B. Sickle Cell Anaemia
C. Pernicious Anaemia
D. Chronic Myeloid leukaemia
E. Hodgkins Lymphoma
F. Acute lymphblastic leukaemia
G. Chronic lymphocytic leukaemia
H. Iron defeciency anaemia
I. Acute myeloid leukaemia
J. Non Hodkins lymphoma
K. Myeloma
L. Haemophilia
A

D. Chronic Myeloid leukaemia

There tends to be massive splenomegaly which is the most common physical finding on examination. The patient may also describe LUQ discomfort or fullness due to the feeling of a mass due to splenomegaly. There are also symptoms of anaemia here due to BM infiltration of leukaemic cells. Bruises are common and are either spontaneous or from minor trauma. All patients have raised WCC. This is CML which tends to present in the 30-60 age group. At presentation 1/3 may be asymptomatic though if symptomatic, it presents with symptoms including fever, weight loss and night sweats. There is myeloid stem cell proliferation and presents with raised neutrophils, metamyelocytes and basophils. CML is associated with the philadelphia chromosome characterised by t(9;22) of bcr-abl. This conditon may transform to AML or ALL in what is known as a ‘blast crisis’. CML responds to imatinib, which is an anti-bcr-abl antibody and gives long term remission in most patients. Exposure to ionising radiation is a risk factor for CML, as well as AML.

21
Q

A 20 year old West Indian lady presents with pain in the chest and hip. She has had episodes of this pain in the past. Investigations showed Hb 6g/dl and reticulocytes 15%

What is the most likely diagnosis?
A. Thalassaemia
B. Sickle Cell Anaemia
C. Pernicious Anaemia
D. Chronic Myeloid leukaemia
E. Hodgkins Lymphoma
F. Acute lymphblastic leukaemia
G. Chronic lymphocytic leukaemia
H. Iron defeciency anaemia
I. Acute myeloid leukaemia
J. Non Hodkins lymphoma
K. Myeloma
L. Haemophilia
A

B. Sickle Cell Anaemia

The reticulocytosis here is as a result of the haemolytic anaemia this patient is suffering due to sickle cell anaemia. The bone pain in the chest and hip is an acute symptom of vaso-occlusive crises. It is generally unusual for someone to reach this age without being aware that they have sickle cell anaemia so in real life, this would be an uncommon way to present. The diagnosis should however be suspected due to the episodes of pain (vaso-occlusive crises) and the findings of anaemia with reticulocytosis. Sickling occurs when RBCs containing HbS become distorted into a crescent shape. Patients with sickle cell anaemia have no HbA at all. If both parents carry the sickle cell gene, there is a 1 in 4 chance of giving birth to a child with sickle cell anaemia.

22
Q

A 50 year old lady with tiredness, weakness, and breathlessness. She also complains of tingling in her fingers and a sore tongue. Investigations showed Hb 5g/dl and MCV 120fl

What is the most likely diagnosis?
A. Thalassaemia
B. Sickle Cell Anaemia
C. Pernicious Anaemia
D. Chronic Myeloid leukaemia
E. Hodgkins Lymphoma
F. Acute lymphblastic leukaemia
G. Chronic lymphocytic leukaemia
H. Iron defeciency anaemia
I. Acute myeloid leukaemia
J. Non Hodkins lymphoma
K. Myeloma
L. Haemophilia
A

C. Pernicious Anaemia

Glossitis is a late sign of vitamin B12 deficiency. The paraesthesia here in the fingers may be an early and subtle symptom of neurological damage due to B12 deficiency. Additionally this patient has anaemic symptoms and investigations show a macrocytic anaemia. The only cause on the list is pernicious anaemia which is a condition with autoimmune destruction of gastric parietal cells leading to a deficiency of intrinsic factor. This causes reduced vitamin B12 absorption from the GI tract. However, anything that decreases either the intake or absorption of B12 can lead to deficiency. This include other conditions such as decreased dietary intake, gastric or intestinal surgery and atrophic gastritis. PPIs and metformin can also lead to deficiency as well as any malabsorption syndrome such as coeliac disease or bacterial overgrowth.

23
Q

An 18 year old girl with tiredness, faintness and heavy periods. Investigations showed Hb 8 g/dl and MCV 65fl

What is the most likely diagnosis?
A. Thalassaemia
B. Sickle Cell Anaemia
C. Pernicious Anaemia
D. Chronic Myeloid leukaemia
E. Hodgkins Lymphoma
F. Acute lymphblastic leukaemia
G. Chronic lymphocytic leukaemia
H. Iron defeciency anaemia
I. Acute myeloid leukaemia
J. Non Hodkins lymphoma
K. Myeloma
L. Haemophilia
A

H. Iron defeciency anaemia

Menstrual iron loss is inversely related to iron status as measured by ferritin. There is menorrhagia here which is likely causing this patient’s IDA, which is a microcytic hypochromic anaemia. The reticulocyte count will be low. Ferritin will also be low with raised TIBC. Initial treatment includes oral iron. Hookworm infection can be a frequent cause of blood loss in the developing world.