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A 45-year-old Singaporean man presents to the GP with lethargy for the…
A 45-year-old Singaporean man presents to the GP with lethargy for the last few months. The GP did a full blood count which shows that the patient is anaemic
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Nutritional
b12
deficiency of gastric IF - pernicious, gastrectomy
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blood count and film, BM aspirate, b12/folate levels, Auto antibodies, test for B12 absorption (radioactive labelled b12, shilling test)
absorptive - crohn's disease, stagnant loop syndrome, tropical sprue, fish tapeworm, congenital malabsoption
iron
GI bleed, ulcer, malignancy
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malabsorption (coeliac disease, atrophic gastritis)
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nail flattening, koilonychia (concave nails), sore tonges, angular stomatitis, dysphagia, gastritis
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folate
risk of thrombosis, hyperhomocysteinaemia
malabsorptive - coeliac disease, tropical sprue, small bower disease / resection
pregnancy, haemolytic anaemia, myeloproliferative disorders
drug induced - folate antagonists, metabolic inhibitors, NO (prolonged use)
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inherited
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RBC cell metabolism
G6PD deficiency
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fava beans, drugs, infections.
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Thalassemia
alpha
Hb-barts - deletion of all 4 genes, death in utero
HbH - deletion of 3. splenomegaly, hepatomegaly, bone and growth changes, hypochromic microcytic RBC with poikolicytosis, polychromasia and target cells.
trait - deletion of 1. lower MCV, MCH.
beta
excess a-chain - toxic. skull bossing an maxillary enlargement. hair on end radiological appearance of the skull.
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Sickle cell
complications - GU (loss of ability to concentrate urine), Skin (lower limb ulceration), Eyes (proliferative retinopathy, glaucoma), Hepatobiliary (liver damage, pigment gallstones)
sickle cell trait
no clinical problems, since there is enough HbA in red cells. 60%.
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