bloods

Question 1

Megaloblastic anaemia

Answer 1

History
– Weakness in arms and legs
– Numbness and tingling in peripheries
– Balance
• Examination
– Smooth red tongue
– Glossitis
– Dorsal column and lateral corticospinal tract signs
• Extra tests
– Hb and RBC ↓
– MCHC N
– Blood film: Hypersegmented neutrophils, ovalocytes, anisocytosis,
poikilocytosis
– B12 and/or folate levels ↓
– LDH ↑
– Homocystine ↑ (B12 and folate deficiency)
– Methylmalonic acid ↑ (B12 deficiency only)

Question 2

Sideroblastic syndromes

Answer 2

Failure to completely form heme molecules
• Iron deposits around nucleus of the developing RBC
• Causes
– Poisoning (lead, copper, zinc) Can check levels
– Drugs
– Bone marrow disorders (MDS)
• Other tests
– Ferritin ↑
– TIBC N
– Serum iron ↑
– Transferrin saturation ↑
– Blood film – Basophilic stippling in lead poisoning
– Bone marrow – Ring sideroblasts