Question 18.2

Created on Mon, 10/12/2015 - 21:20
Last updated on Tue, 05/08/2018 - 19:08
Pass rate: 46%
Highest mark: 6.7

Other SAQs in this paper

Other SAQs on this topic

The following data refer to a 48-year-old female admitted electively to ICU following extensive pelvic surgery for invasive endometrial carcinoma. The patient has remained in ICU for 22 days because of complications including acute kidney injury.

Parameter Patient Value Normal Adult Range
Haemoglobin 66 g/L* 125 – 180
Serum ferritin 14 μg/L* 15 – 300
Serum iron 3 μmol/L* 9 – 27
Total Iron Binding Capacity (TIBC) 86 μmol/L* 47 – 70
Transferrin Saturation 9%* 16 – 40
Erythropoietin level 41 U/L* 4 – 28
C-reactive protein (CRP) 60 mg/L* <8

a) What abnormality is demonstrated in this patient? Give your reasoning. (20% marks)

b) Give two potential causative factors in this patient. (10% marks)

c) Briefly outline the available treatment options to correct the demonstrated abnormality including any disadvantages / risks. (20% marks)

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College Answer

a)

Iron deficiency anaemia as evidenced by:

  • decreased haemoglobin
  • decreased iron
  • decreased ferritin
  • increased erythropoietin
  • increased TIBC.

b)

Blood loss
Pre-existing dietary deficiency

c)

IV iron replacement – no demonstrated benefit and risks of adverse effects (awaiting Ironman study)
Oral iron replacement
Erythropoeitin – expensive and no demonstrated benefit
Blood transfusion – risks of transfusion including immunosuppression
Nil – may have reduced oxygen carrying capacity for some time until correction of Hb

Discussion

Local resources to help with such questions include the following chapters:

In the above, there is a table of typical findings which is reproduced below:

Interpretation of Abnormal Iron Studies
Condition MCV MCHC Serum iron Ferritin Transferrin Transferrin
saturation
TIBC
Iron deficiency anaemia low low low low high <20% high
Anaemia of chronic disease low low low normal low normal low or normal
Acute phase response normal normal low high low low low
Iron overload normal normal high high normal high high