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Case 8

Blood film showing typical microcytic hypochromic red cells

This is a blood film from a 54 year old perimenopausal lady found to have iron deficiency anaemia. The film shows typical microcytic hypochromic red cells.

1
Question 1

Which of the following statements are true concerning iron deficiency anaemia? (Tick all that apply)

a)
b)
c)
d)

Correct. In iron deficiency anaemia, bone marrow stores of iron are completely depleted. Iron is needed for haem synthesis. The incidence of iron deficiency anaemia is greater in women, principally related to menstrual blood loss and pregnancy. In young patients with a clear source of chronic blood loss (e.g. a young women with heavy menstrual periods), endoscopy is not mandatory.

Incorrect. In iron deficiency anaemia, bone marrow stores of iron are completely depleted. Iron is needed for haem synthesis. The incidence of iron deficiency anaemia is greater in women, principally related to menstrual blood loss and pregnancy. In young patients with a clear source of chronic blood loss (e.g. a young women with heavy menstrual periods), endoscopy is not mandatory.

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2
Question 2

Which of the following statements are true regarding the anaemia in this patient? (Tick all those that apply)

a)
b)
c)
d)

Correct. Gluten-sensitive enteropathy often presents with iron deficiency anaemia in the absence of any gastrointestinal symptoms, and should be considered. Around the time of the menopause, the frequency of periods can be erratic and increased, and there can be menorrhagia. Angiodysplasia is a degenerative lesion of previously healthy blood vessels, found most commonly in the caecum and proximal ascending colon; such lesions are liable to bleed.

Incorrect. Gluten-sensitive enteropathy often presents with iron deficiency anaemia in the absence of any gastrointestinal symptoms, and should be considered. Around the time of the menopause, the frequency of periods can be erratic and increased, and there can be menorrhagia. Angiodysplasia is a degenerative lesion of previously healthy blood vessels, found most commonly in the caecum and proximal ascending colon; such lesions are liable to bleed.

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The patient underwent a variety of further tests to investigate the cause of the iron deficiency anaemia.

3
Question 3

Which of the following statements are correct? (Tick all that apply)

a)
b)
c)
d)

Correct. An erythematous appearance of the gastric antrum is a common endoscopic finding and is often due to a reactive gastritis in people taking NSAIDs or people with bile reflux into the stomach; it does not cause chronic blood loss and iron deficiency anaemia. Faecal occult blood tests can be positive with non-neoplastic conditions e.g. haemorrhoids. A negative serum endomysial antibody makes gluten-sensitive enteropathy very unlikely. Hyperplastic polyps are common small mucosal lesions of the large bowel which do not give rise to iron deficiency anaemia.

Page reference (for whole case): 334-5

Incorrect. An erythematous appearance of the gastric antrum is a common endoscopic finding and is often due to a reactive gastritis in people taking NSAIDs or people with bile reflux into the stomach; it does not cause chronic blood loss and iron deficiency anaemia. Faecal occult blood tests can be positive with non-neoplastic conditions e.g. haemorrhoids. A negative serum endomysial antibody makes gluten-sensitive enteropathy very unlikely. Hyperplastic polyps are common small mucosal lesions of the large bowel which do not give rise to iron deficiency anaemia.

Page reference (for whole case): 334-5

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