Feeling tired

ISBAR Introduction: My name is Dr. X, a GP in Brisbane. Situation: Miss Agnes B is 92 years old, has been lethargic for the past 5-6 months, has poor appetite, blood results show low Hb and RBC, high bilirubin, antibody for intrinsic factor, endoscopy reveals atrophic gastritis Background: Had a partial gastrectomy  stomach ulcer was malignant, no other significant past medical hx, currently on iron supplements Assessment: She has anemia due to a vitamin B12 deficiency and atrophic gastritis Recommendation: Miss B is seeking a second opinion on her management

Exam paper – 2006 PSA 1 PART A2 Paul is a 27 year old house painter. He is usually fit, and in fact regularly runs in marathons. He had a sore throat and “swollen glands” in his neck, and saw another doctor who gave him penicillin. His sore throat has settled but he feels worse. He is so exhausted that he cannot do any running at all.

On further questioning, Paul says his urine is dark, and he is not just too tired to run, he is actually short of breath. You find that he is very pale, and slightly jaundiced. You suspect that he has a haemolytic anaemia, and arrange for haematological tests. His full blood count demonstrates:

Hb 93 ( g/L) RCC 3.8 ( x 1012/L) MCV 105 ( fL) PCV 27% (40-54 %) Reticulocyte count 5% (<2%) Comment: some anisocytosis and polychromasia

Question 1. (12 marks) Explain the mechanism(s) behind the changes in each of the abnormal parameters. Question 2. (4 marks) Explain the mechanism of jaundice in haemolytic anaemia.

Question 3. (6 marks) What changes (if any) would you expect in the levels of the following parameters in haemolytic anaemia? Briefly explain your answer. (a) serum lactate dehydrogenase (b) serum haptoglobin (c) urinary urobilinogen

Question 4. (4 marks) List four (4) possible causes of Paul’s haemolysis.