Welcome to your Some more clinical hematology case based mcqs
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 ร 109/l, Hb 83 g/l, platelet count 221 ร 109/l, neutrophils 7.2 ร 109/l and lymphocytes 91 ร 109/l. Her blood ๏ฌlm 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 ร 109/l, neutrophil count 1.1 ร 109/l, Hb 100 g/l, MCV 104 ๏ฌ and platelet count 70 ร 109/l. Blood ๏ฌlm 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 ๏ฌare of her rheumatoid arthritis. Her FBC shows WBC 12.0 ร 109/l, RBC 3.62 ร 1012/l, Hb 83 g/l, Hct 0.27 l/l, MCV 74 ๏ฌ, MCHC 310 g/l, platelet count 441 ร 109/l and neutrophils 9.2 ร 109/l. Her blood ๏ฌlm shows increased rouleaux formation and the ESR is 65 mm in 1 h (<20). Serum ferritin is 47 ฮผg/l (14โ200), serum iron is 6 ฮผmol/l (11โ28) and total iron binding capacity 65 ฮผmol/l (45โ75). 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 ร 109/l, Hb 105 g/l, Hct 0.30 l/l, MCV 79 ๏ฌ, MCH 27.6 pg, MCHC 350 g/l, red cell distribution width (RDW) 15% (9.5โ15.5), platelet count 403 ร 109/l and reticulocyte count 120 ร 109/l. His blood ๏ฌlm 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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