Heam

Question 1

iron studies and haematinic testing, however, reveals an increased serum ferritin, transferrin saturation and serum iron.

A blood film shows a hypochromic, microcytic anaemia (as expected from the full blood count), but also shows basophilic granules, staining positive for iron (known as Pappenheimer bodies).

Answer 1

Sideroblastic anaemia

This is the correct answer. Sideroblastic anaemia is a rare cause of a hypochromic, microcytic anaemia which mimics iron deficiency; but is distinguished by high serum ferritin and iron levels. It may be congenital or acquired. Acquired causes include drug-induced sideroblastic anaemia, and cases related to isoniazid use (and pyridoxine deficiency) are well documented in the literature. In addition, basophilic granules staining positive for iron (known as Pappenheimer bodies) are typical.

Question 2

A 60-year-old male patient is admitted to hospital due to an enlarged rubbery neck lymph node that is starting to cause stridor. The lymph node biopsy confirms high grade diffuse large B-cell Lymphoma. The patient is due to be started on the R-CHOP chemotherapy regimen.

Which of the following should be prescribed before starting chemotherapy?

Answer 2

Rasburicase (recombinant xanithine oxidase)

This patient is at high risk of tumour lysis syndrome due to the high grade nature of his cancer. Rasburicase prescribed to protect against urate build up and tumour lysis syndrome and works by converting uric acid into allantoin to prevent hyperuricaemia. It is important to consider tumour lysis syndrome in patients with high grade tumours, leukaemias and lymphomas and take bloods twice daily for patients under going chemotherapy especially if they have a large lymph nodes where chemotherapy is likely to cause large amounts of cell death. Note Rasburicase can induce haemolysis in G6PD therefore allopurinol.