EMQs in Clinical Medicine.pdf - Peshawar Medical College

Haematology and oncology – revision boxes 69
REVISION BOXES
Haematology and oncology
Results of the peripheral blood film are often a good clue to the answer in an
EMQ (Box 1).
Box 1 On the peripheral blood film [22]
Film
Condition
Howell–Jolly bodies
Hyposplenism
Burr cells
Uraemia
Heinz bodies
Glucose-6-phosphate dehydrogenase deficiency
Reticulocytosis
Bleeding, haemolysis
Target cells
Liver disease, iron deficiency anaemia
The patient with anaemia is frequently found in EMQs. You should be aware of all
the causes of a macrocytic, microcytic and normochromic anaemia because this
will rapidly help you to eliminate options.
Box 2 summarizes some features of causes of anaemia that are common in
EMQs.
Box 2 Anaemia [21]
Patient has macrocytic anaemia:
• With glossitis, peripheral neuropathy
• And is on drugs, e.g. phenytoin,
trimethoprim
• With dry, thin hair, slowly relaxing
reflexes
• Alcohol can cause a macrocytic anaemia
and a macrocytosis without anaemia
Patient has microcytic anaemia:
• And menorrhagia
• And is on chronic NSAID (non-steroidal
anti-inflammatory drug) treatment
• With an increased HbF
Vitamin B 12 deficiency
Folate deficiency
Hypothyroidism
Iron deficiency anaemia
Iron deficiency anaemia
-Thalassaemia
continued overleaf