Case 38


A 53-year-old gentleman with good past health presents to the outpatient clinic with a 3-month history of malaise and shortness of breath on exertion. He has a normal appetite and no weight loss.

Physical examination

Temperature 37°C, pulse 120 bpm, BP 100/60mmHg, SaO2 98-100% on RA.

Hydration is satisfactory.

Examination of the hands reveals no clubbing and normal-appearing palmar creases.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

His chest is clear on auscultation.

Abdominal examination reveals a soft, non-tender abdomen.

PR melaena.

No signs of oedema.



WBC 9.6 x 109/L;

haemoglobin 6g/dL;

platelets 265 x 109/L.

Pre-transfusion blood results:

MCV 74fL;

serum iron 5μmol/L;

TIBC 80μmol/L;

ferritin 25pmol/L;

blood film shows hypochromic red blood cells with poikilocytosis and anisocytosis.

Post-transfusion haemoglobin level is 9.5g/dL.

What is the differential diagnosis of microcytic anaemia 1?

Iron deficiency anaemia.


Anaemia of chronic illness.

Sideroblastic anaemia.

What are the typical features of the CBC and iron profile for the possible causes of microcytic anaemia?

The typical features of the CBC and iron profile for the possible causes of microcytic anaemia are listed in Table 38.1.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 38

Full access? Get Clinical Tree

Get Clinical Tree app for offline access

Table 38.1. Differential diagnosis of microcytic anaemia 1.

Iron deficiency

Anaemia of chronic illness

Thalassaemia trait

Sideroblastic anaemia


↓ or normal