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Haematology: breathlessness

Mr Lawrence, a 54 year old man, decided to visit his GP as he was experiencing some shortness of breath (SOB) that he hadn’t noticed before. The SOB comes on with climbing stairs or hills, but is fine at rest and lying down. He has noted some dizziness with the SOB and tingling in his fingers. However, there has been no chest pain, fever, weight loss. He has no past medical history of note, no drug history and does not smoke. He is a moderate drinker who was recently in France as he is a lorry driver. Based on this history, how is the GP likely to proceed?

The GP examines Mr Lawrence from head to toe and finds nothing of note except some pallor of the conjunctiva. At this stage which of the following diagnoses is the GP most likely to be considering?

The GP decides to perform some blood tests and an ECG to investigate Mr Lawrence further. Which 3 of the following blood tests is the GP most likely to order for the purpose of diagnosing Mr Lawrence?

Two days later Mr Lawrence returns for his blood results. The GP looks at his screen and sees the following:
FBC: Hb 9.8, WCC 5.6, MCV 112, Plts 342
U&E: Na+ 141, K+4.1, Urea 5.3
LFT: Bili 21, Albumin 43
CRP: <10
B12 and folate: B12 37, Folate 14
Ferritin: 109
D-dimer: <0.3
Based on these results, what diagnosis can the GP give Mr Lawrence?

Which of the following are causes of this type of anaemia?

The GP explains to Mr Lawrence that there are many possible causes for his anaemia, and decides to ask a few more questions to help him identify the cause. Mr Lawrence is not a vegetarian or vegan. He has never had any abdominal surgery. Mr Lawrence’s mother did have anaemia (now that he thinks about it)…and her doctor told her it was something to doing with her body attacking itself. Within this in mind the GP decides that he might test for intrinsic factor and parietal cell antibodies. These antibodies are often associated with which cause of B12 deficient anaemia?

Whilst waiting for the results the GP considers whether Mr Lawrence will require a blood transfusion. Is the GP likely to give a blood transfusion to Mr Lawrence?


The results of Mr Lawrence’s blood tests arrive and the GP explains to him that he is most likely to have pernicious anaemia. What treatment will the GP offer Mr Lawrence?

In which part of the intestines is B12 absorbed?

 
Six months later Mr Lawrence returns to his GP. He reports that his SOB, and the tingling in his fingers has resolved. The GP informs his that his Hb is returning to normal and his B12 levels are optimal.
 
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norm

Normal conjunctiva.

pallor

Conjunctival pallor. © 1997 T. N. Sheth.






































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