Online OSCEs - Station THREE - Full blood picture interpretation

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A 64 year old female is concerned about a lack of energy in recent months. A full blood picture is requested.

Hb: 8.6 g/dl

MCV: 64 fl

MCH: 25 pg

MCHC: 28 g/dl

Plt: 203 x 10⁹/l

WCC: 8.4 x 10⁹/l

Question 1: What type of anaemia does this patient have? (1 mark)

Question 2: Deficiency of which haematinic is the commonest cause of this type of anaemia? (1 mark)

Question 3: Would you expect the following to be high, low or normal in this patient? (2 marks)

(a) Serum iron

(b) Total iron binding capacity

Question 4: On further questioning, it becomes apparent that the patient has had difficultly swallowing recently.

Suggest 2 suitable next-line investigations (2 marks).

Question 5: The patient is found to have a web in her oesophagus.

What syndrome does she have?

Answer 1:	What type of anaemia does this patient have? A microcytic (low MCV, = 1 mark), hypochromic (low MCH and MCHC, = 1 mark) anaemia.
Answer 2:	Deficiency of which haematinic is the commonest cause of this type of anaemia? Iron
Answer 3:	Would you expect the following to be high, low or normal in this patient? (a) Serum iron - Low (b) Total iron binding capacity - High (1 mark for each correct answer)
Answer 4:	On further questioning, it becomes apparent that the patient has had difficultly swallowing recently. Suggest 2 suitable next-line investigations. Barium swallow Barium meal Oesophago-gastro-duodenoscopy (OGD) (1 mark for each answer, to a maximum of 2 marks).
Answer 5:	The patient is found to have a web in her oesophagus. What syndrome does she have? The Patterson-Brown-Kelly syndrome (also known as the Plummer-Vinson syndrome). (3 marks for the correct answer).