1A 68 year old man reports [rpgressive fatigue. Hib blood test results are shown below.
Hameglobin: 96g/L (130-170)
MCV: 72fl ( 80-100)
Ferritin: 8micrograms/L ( 30-400)
CRP: 3mg/L (Less than 5)
While iron replacement is started, what is the single best next step?
- Check coeliac serology and urine dipstick for blood alone
- Empiric erythropoeisis stimulating agent therapy
- Gastro intestinal evaluation for pathology
- Order hepcidin and soluble transferrin receptor testing
- Recheck haemoglobin after iron treatment and if normal no further investigations
2A 36 year old woman with SLE diagnosed six months ago presents with worsening fatigue for the last three weeks. Her blood test results are shown below:
Hameglobin: 84g/L (120-160)
MCV: 70fl ( 80-100)
Ferritin: 45 micrograms/L ( 30-150)
CRP: 38mg/L (Less than 5)
What is the best interpreation of his results?
- Ferritin in the reference range excludes iron deficiency
- The raised CRP proves that absolute iron deficiency is absent
- The results are compatitible with mixed IDA and ACI
- The results suggest pure anaemia of chronic inflammation
- The short symptom history makes iron deficiency unlikely
3A 34 year old woman with active Crohn's disease has been taking once daily oral iron for four weeks with no improvement and has ongoing GI symptoms. Her blood test results are shown below.
Hameglobin: 88g/L (120-160)
MCV: 76fl ( 80-100)
Ferritin: 40 micrograms/L ( 30-150)
CRP: 18mg/L (Less than 5)
What is the single best management choice now?
- Continue the same oral iron for another three months
- Give intravenous iron while treating the inflammatory flare
- Give red cell transfusion as routine first line treatment
- Start erythropoesis stimulating therapy alone
- Stop oral iron treatment and observe until Crohn's disease is controlled
4A 60 year old man with untreated polymyalgia rheumatica feels fatigued but can carry out activities of daily living and denies dyspnea on exertion or chest pain. His blood test results are shown below.
Hameglobin: 106g/L (130-170)
MCV: 87fl ( 80-100)
Ferritin: 510 micrograms/L ( 30-400)
CRP: 62mg/L (Less than 5)
Transferrin saturation: 20% (20-45)
What is the most appropriate initial management principle?
- Begin long term oral iron alone
- Control the underlying inflammatory disease
- Immediate intravenous iron treatment
- Give red cell transfusion as routine first line treatment
- Repeat the blood count in one month without intervention
5A 46 year old woman reports fatigue, dizziness and heavy menstrual bleeding. Her blood test results are shown below.
Hameglobin: 92g/L (120-160)
MCV: 73fl ( 80-100)
Ferritin: 7 micrograms/L ( 30-150)
CRP: 2 mg/L (Less than 5)
RDW: 17.2% ( 11.5 - 14.5)
Serum iron: 3 ( 10-30)
What additional pattern would best fit uncomplicated iron deficiency anaemia?
- High hepcidin with low transferrin and low total iron binding capacity
- High hepcidin with normal transferrin and normal total iron binding capacity
- Low hepcidin with high transferrin and high total iron binding capacity
- Low hepcidin with high transferrin saturation and high total iron binding capacity
- Low hepcidin with low transferrin and low total iron binding capacity
6A 38 year old woman with coeliac disease reports fatigue, mouth soreness, and reduced exercise tolerance, Physical exam is notable for conjunctival pallor, angular cheilitis, dry skin and thinning hair. Her blood tests are shown below.
Hameglobin: 83g/L (120-160)
MCV: 94fl ( 80-100)
Ferritin: 30 micrograms/L ( 30-150)
CRP: 16mg/L (Less than 5)
Transferrin saturation: 8% ( 20-45)
RDW: 27% ( 11.5-14.5)
What is the best interpretation of these results?
- Combined iron and folate deficiency
- Isolated folate defciency alone
- Pure anaemia of chronic inflammation
- Pure iron deficiency anaemia
- Raised CRP makes ferritin uninterpretable, so iron status cannot be assessed
7A 69 year old man with stage 3 chronic kidney disease reports fatigue and reduced exercise tolerance. He has no visible bleeding, change in bowel habit or weight loss. His blood test are shown below:
Hameglobin: 104g/L (130-170)
MCV: 77fl ( 80-100)
Ferritin: 360 micrograms/L ( 30-400)
CRP: 18 mg/L (Less than 5)
RDW: 15.2% (11.5-14.5)
Transferrin saturation : 18% ( 20-45)
Reticulocyte count: low
Which mechanism best explains this patient's anaemia?
- Absolute iron deficiency from depleted stores
- Erythropoeitin deficiency with adequate iron delivery to the marrow
- Erythropoeitin deficiency with inflammation driven functional iron restriction
- Inflammation alone, with kidney function incidental to the anaemia
- Mixed anaemia of chronic inflammation and absolute iron deficiency
8A 72 year old man with stable coronary artery disease develops iron deficiency anaemia. He now experiences exertional chest tightness that resolves with rest. His haemoglobin is 76g/L, oxygen saturation is 98% on room air, and there are no clinical features of primary respiratory disease.
Which physiological change most directly explains why his anaemia can precipitate mycordial ischaemia despite normal oxygen saturation?
- Decreased haemoglobin concentration reducing arterial oxygen concentration
- Increased alevolar dead space reducing effective ventilation
- Increased carboxyhaemoglobin reducing oxygen saturation
- Reduced arterial oxygen tension
- Right to left shunt of deoxygenated blood