For each case of anaemia A–E, select the most appropriate option from the following list.
1. Iron deficiency anaemia.
2. Pernicious anaemia.
3. Microcytic anaemia.
4. Macrocytic anaemia.
5. Normocytic anaemia.
6. Bone marrow disease.
7. Compensatory rise in cardiac output.
8. Decreased blood viscosity.
9. Haemolytic anaemia.
10. Increased bone marrow activity
- Normal under the microscope. The mean red cell volume is normal at 90 cubic microns.
- A patient with long-standing indigestion has noticed increasing lack of energy and tiredness when walking uphill. On questioning he has noticed that the bowel motions are unusually dark from time to time. Due to the indigestion the patient takes a bland d
- A patient with a blood haemoglobin concentration of 60 grams per litre complains of recent palpitations (an abnormal awareness of the heart beat, often rather fast). When at rest, the pulse is 110 per minute and the blood pressure 140/60 mmHg.
- A woman of 75 has noticed unusual lack of energy recently and feels she is paler than usual. Her haemoglobin level is 110 grams per litre and the red cell count is depressed beyond that expected with the fall in haemoglobin. The circulating level of vitam
- A patient with moderate anaemia is found to have a bruit (abnormal murmur) when a stethoscope is used to listen over each of the carotid arteries in the neck. The doctor is inclined to attribute the murmur to a physical effect of the anaemia on the blood
Medicine
A. Option 5 Normocytic anaemia. The haemoglobin concentration is about half normal, indicating moderate anaemia. Since the red cells look normal and mean cell volume is also normal this is a normocytic anaemia. It could be due to bone marrow disease, lack of erythropoietin or other chronic disease.
B. Option 1 Iron deficiency anaemia. This patient has symptoms of anaemia, along with a suggestion of repeated bleeding into the bowel and a diet likely to be low in iron. The most likely explanation is anaemia due to iron deficiency. This is likely to be a microcytic anaemia, but no confirmatory details of the presence of small pale red cells are given in this case.
C. Option 7 Compensatory rise in cardiac output. This patient has severe anaemia. In order to provide adequate oxygen for the tissues, the low oxygen content per litre must be compensated by increased flow. This patient shows the features – fast pulse, high pulse pressure – of an increased resting cardiac output (hyperdynamic circulation).
D. Option 2 Pernicious anaemia. This patient has moderately severe anaemia. Because the red cell count is disproportionately low, the cells must be larger than normal – macrocytic. This is explained by the low level of vitamin B12 and the normal folate excludes another major macrocytic anaemia. The B12 deficiency at this age is usually due to failure of the stomach to produce intrinsic factor – pernicious anaemia. The term pernicious was used because before the discovery of vitamin B12 there was no treatment and the condition got worse and worse until the patient died from an extremely low level of haemoglobin.
E. Option 8 Decreased blood viscosity. A bruit or murmur in the circulation indicates turbulent flow. Turbulent flow is much more likely as the viscosity of blood decreases. Since most of the blood viscosity is due to the haematocrit, moderate anaemia could reduce the viscosity by around half. The increased velocity of flow due to the increased cardiac output mentioned in (C) would also increase the chance of turbulence.
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