EMQ: 4
Anaemia
a)
Hereditary spherocytosis
b)
Iron deficiency anaemia
c)
Folic acid deficiency anaemia
d)
Vitamin B12 deficiency anaemia
e)
Sickle cell disease
f)
Thalassaemia major
g)
Thalassaemia minor
h)
Sideroblastic anaemia
i)
Anaemia of chronic disease
j)
Aplastic anaemia
Select the most likely cause of anaemia from the list
above to match the scenarios given below:
1) A 25-year-old male has a macrocytic anaemia. He is on
long-term treatment with phenytoin sodium for epilepsy
Answer: c) folic acid deficiency anaemia
A macrocytic anaemia may be due to deficiency of vitamin
B12 or folic acid. Other causes such as alcohol abuse,
hypothyroidism, drug treatment with drugs such as azathioprine are not
relevant to this case. Anticonvulsant drugs (for example phenytoin sodium)
interfere with mucosal conjugase. This impairs folate absorption.
2) A 58-year-old northern European female with a
macrocytic anaemia. She has blue eyes, white hair and has vitiligo.
Answer: d) vitamin B12 deficiency anaemia
Macrocytic anaemia may be due to vitamin B12
or folate deficiency. Other causes as outlined above are not relevant to this
case. In an elderly female one should consider pernicious anaemia. Pernicious
anaemia is more common in people of northern Europe, and is associated with
blue eyes, premature greying of the hair and vitiligo.
3) A 23-year-old African patient presents with severe
pain in his femur and is found to be anaemic
Answer: e) sickle cell disease
The fact that the patient is an African should alert one
to the possibly of a disease more common in a person of that ethnic origin.
Severe bone pain should be the clue to the diagnosis. Vasoocclusive crises
occur in patients with sickle cell disease and results in severe pain, which
is of ischaemic origin.
4) A 53-year-old postmenopausal female presents with a
history of lethargy and is found to have a mass in the right iliac fossa.
Answer: b) iron deficiency anaemia
In a female presenting with anaemia none should always
consider menstrual disturbances. The patient is postmenopausal and hence this
does not come into consideration. The lump in the right iliac fossa should
make one consider carcinoma of the caecum with consequent iron deficiency.
5) A 58-year-old female with long standing rheumatoid
arthritis has a normocytic, normochromic anaemia. White cell count and
platelets are within normal limits. She has normal iron studies, her folate
and B12 levels are normal and there is no reticulocytosis.
Answer: I) anaemia of chronic disease
In a patient with rheumatoid arthritis anaemia may be due
to multiple causes.
Haematinic
deficiency, marrow failure and haemolysis have been excluded by the
information given. Thus the most likely cause is anaemia of chronic disease.
Revision Tip
Revise the causes of anaemia
ACES for PACES pages 363-369
