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.
•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.
•No signs of oedema.
–WBC 9.6 x 109/L;
–platelets 265 x 109/L.
•Pre-transfusion blood results:
–serum iron 5μmol/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.
The typical features of the CBC and iron profile for the possible causes of microcytic anaemia are listed in Table 38.1.
Anaemia of chronic illness
↓ or normal