ISBAR • Introduction: My name is Dr. X, a GP in Brisbane. • Situation: Miss Agnes B is 92 years old, has been lethargic for the past 5-6 months, has poor appetite, blood results show low Hb and RBC, high bilirubin, antibody for intrinsic factor, endoscopy reveals atrophic gastritis • Background: Had a partial gastrectomy stomach ulcer was malignant, no other significant past medical hx, currently on iron supplements • Assessment: She has anemia due to a vitamin B12 deficiency and atrophic gastritis • Recommendation: Miss B is seeking a second opinion on her management
Exam paper – 2006 PSA 1PART A2 Paul is a 27 year old house painter. He is usually fit, and in fact regularly runs inmarathons. He had a sore throat and “swollen glands” in his neck, and saw anotherdoctor who gave him penicillin. His sore throat has settled but he feels worse. He isso exhausted that he cannot do any running at all.
On further questioning, Paul says his urine isdark, and he is not just too tired to run,he is actually short of breath. You find that he is very pale, and slightly jaundiced. Yoususpect that he has a haemolyticanaemia, and arrange for haematological tests. Hisfull blood count demonstrates:
Hb 93 (130-180 g/L) • RCC 3.8 (4.5-6.5 x 1012/L) • MCV 105 (80-100 fL) • PCV 27% (40-54 %) • Reticulocyte count 5% (<2%) • Comment: some anisocytosis and polychromasia
Question 1. (12 marks) • Explain the mechanism(s) behind the changes in each of the abnormal parameters. • Question 2. (4 marks) • Explain the mechanism of jaundice in haemolyticanaemia.
Question 3. (6 marks) • What changes (if any) would you expect in the levels of the following parameters inhaemolyticanaemia? Briefly explain your answer. • (a) serum lactate dehydrogenase • (b) serum haptoglobin • (c) urinary urobilinogen
Question 4. (4 marks) • List four (4) possible causes of Paul’s haemolysis.