Hussnain Javaid: The Importance of Targeted Examination in Iron Deficiency Anaemia
Hussnain Javaid, Consultant Haematologist at NHS UK, Founder of ClinHaem, shared a post on LinkedIn:
“Investigations without history and examination can be blind!
You are seeing a 52-year-old White Caucasian man in the clinic who has been referred to you for further evaulation of his recurrent iron deficiency anaemia.
Background
- Hypertension only
- Medications: Ramipril, intermittent oral iron over several years
History
- 5-year history of recurrent iron deficiency anaemia detected on routine blood tests
- Multiple courses of oral iron with only transient improvement
- Required two intravenous iron infusions in the past 2 years
- Ferritin rises with treatment but falls again after cessation
- Absolutely denies gastrointestinal symptoms including abdominal pain, change in bowel habit or overt GI bleeding including malena.
- No bleeding in the urine.
- Stools and urine are normal color.
- Has repeatedly declined OGD and colonoscopy
Additional history reveals
- Intermittent epistaxis
- No excessive bleeding despite three previous major orthopaedic surgeries involving the knee joint and femur following trauma
- Father also required recurrent intravenous iron infusions
Blood tests
Hb: 102 g/L (130–180)
MCV: 74 fL (80–100)
MCH: 23 pg (27–32)
Platelets: 410 ×10⁹/L (150–400)
Ferritin: 14 µg/L (30–300)
PT: 12.1 s (11–14)
APTT: 29 s (25–35)
Fibrinogen: 3.1 g/L (2.0–4.0)
VWF:Ag: 108 IU/dL (50–200)
VWF:Act (RCoF): 96 IU/dL (50–200)
Factor VIII: 118 IU/dL (50–150)
Question
Which of the following is the most appropriate targeted clinical examination to help identify the underlying diagnosis?
Options
A. Examination of the skin and joints
B. Examination of the conjunctivae and nails
C. Examination of the lips, oral mucosa and fingertips
D. Examination of the spleen and lymph nodes
E. Examination of dependent areas of the skin
Please provide a brief explanation of your answer as well.
Answer out later on!
P.S. week 4 and 5 = Thalassaemia and SCD respectively so stay tuned for some haemoglobinopathy questions!
Details on ClinHaem.”
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