Some more clinical hematology case based mcqs

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A 69-year-old Afro-Caribbean woman is referred to rheumatology outpatients because of painful joints and morning stiffness. She is found to have a minor degree of lymphadenopathy and her spleen is tipped on inspiration. An FBC shows WBC 98 × 109/l, Hb 83 g/l, platelet count 221 × 109/l, neutrophils 7.2 × 109/l and lymphocytes 91 × 109/l. Her blood film shows mature small lymphocytes with scanty cytoplasm, round nuclei and coarsely clumped chromatin. Smear cells are present. Rheumatoid factor is detected and her erythrocyte sedimentation rate (ESR) is 54 mm in 1 h (<20). The most likely diagnosis is:
2. A 23-year-old woman is hospitalised with severe anorexia nervosa. Her FBC shows WBC 3.5 × 109/l, neutrophil count 1.1 × 109/l, Hb 100 g/l, MCV 104 fl and platelet count 70 × 109/l. Blood film shows occasional acanthocytes. Neutrophils show normal segmentation. Her prothrombin time (PT) is slightly increased. The most likely diagnosis is:
3. A 60-year-old woman is referred back to rheumatology outpatients as she has suffered a flare of her rheumatoid arthritis. Her FBC shows WBC 12.0 × 109/l, RBC 3.62 × 1012/l, Hb 83 g/l, Hct 0.27 l/l, MCV 74 fl, MCHC 310 g/l, platelet count 441 × 109/l and neutrophils 9.2 × 109/l. Her blood film shows increased rouleaux formation and the ESR is 65 mm in 1 h (<20). Serum ferritin is 47 μg/l (14–200), serum iron is 6 μmol/l (11–28) and total iron binding capacity 65 μmol/l (45–75). The most likely explanation of the microcytic anaemia is:
4. A 60-year-old Caucasian man presents with a history of fatigue, nausea, abdominal discomfort, altered bowel function, insomnia, anxiety and altered taste. He is a self-employed painter and decorator with a past history of a coronary artery bypass and is taking atorvastatin. His FBC shows WBC 7.8 × 109/l, Hb 105 g/l, Hct 0.30 l/l, MCV 79 fl, MCH 27.6 pg, MCHC 350 g/l, red cell distribution width (RDW) 15% (9.5–15.5), platelet count 403 × 109/l and reticulocyte count 120 × 109/l. His blood film shows anisocytosis, polychromasia, basophilic stippling and occasional nucleated red blood cells and myelocytes. A bone marrow aspirate shows dyserythropoiesis with abnormal sideroblasts including 3% ring sideroblasts. The most likely diagnosis is:
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