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BOF: 28

A 59-year-old woman is under investigation for amaurosis fugax. She has been started on enalapril and low dose aspirin for newly diagnosed hypertension and a TIA affecting her left arm. She has been previously well, smokes 5 cigarettes per day and drinks two glasses of sherry per night.

On examination, she looks well. BP 165/95, pulse 70 regular. There is a 2/6 ejection systolic murmur over the aortic area. The lungs are clear, but there is a mass palpable in the left upper quadrant of the abdomen. No lymph nodes are palpable, and neurological examination is normal.

Bloods:

Hb                   15.8 g/dL

MCV               67fl

MCHC                        26 g/dL

WCC               14.2x109/L

Plts                   489x109/L

Haematocrit            0.58

Blood film            Hypochromia, polychromasia

U&Es, calcium, LFTs – normal

What would be your first-line treatment?

a) 5 hydroxyurea

b) Aspirin

c) Venesection

d) Methotrexate

e) Splenectomy

 

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