Return to Scenario ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Haematology, Digestive System, Medical Genetics
Progress Test Topic(s)
Blood and lymph, Digestive
A 38 year old Indian woman presents to her GP with a 3 month history of worsening fatigue. She has been a vegetarian for the last 12 months. She has regular menstrual periods and no history of menorrhagia. A blood test shows a low haemoglobin of 83 g/L. Her creatinine is elevated at 180 µmol/L.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and physiology of haematopoiesis
   - Dietary sources, absorption, transportation, storage and role of iron, folate, and vitamin B12
   - Structure of haemoglobin
   - Oxygen and carbon dioxide transport in the blood
   - Genetics of inherited haemoglobinopathies and thalassaemias
   - Role of hepcidin in iron regulation and the anaemia of chronic disease
Clinical and Communication Skills 
   - History from a patient with anaemia; consider nutritional deficiencies, inherited anaemias, blood loss, inflammatory disorders and malignancies
   - Examination of the patient with anaemia; recognise lymphadenopathy and hepatosplenomegaly
   - Perform venepuncture; importance of correct patient identification in collecting blood samples
   - Interpret full blood count, reticulocyte count, iron studies, vitamin B12/folate levels, and result from haemoglobinopathy screen
   - Morphological classification and differential diagnosis of anaemia
   - Indications for haemolysis screen, bone marrow biopsy, faecal occult blood, and gastrointestinal tract endoscopies
   - Role of nutrition in anaemia and awareness of your personal perception on patient's choice of diet
   - Management of microcytic and macrocytic anaemias; indications for transfusion of blood products
   - Risks and complications related to transfusion of blood products
   - Outline management issues for a couple with a family history of a haemoglobinopathy or thalassaemia, who are planning a pregnancy
Personal and Professional Skills 
   - Importance of a balanced diet on health and wellbeing; respect patient's perspective on lifestyle choices
   - Beneficence and respect for autonomy; patient refusing life-saving treatment
   - Equipoise and enrolling patients in research
Hauora Māori 
   - Differing risk profiles for anaemia in Māori (and other disadvantaged populations) compared with non-Māori in New Zealand
   - Disproportionate impact of socioeconomic deprivation on Māori including access to adequate nutrition and expensive treatments
Population Health 
   - Epidemiology of anaemia: common scenarios and population distribution
   - Epidemiology of thalassaemias: ethnicity, age, gender and prevalence
Conditions to be considered relating to this scenario
iron deficiency, anaemia of chronic disease, vitamin B12/folate deficiency, renal disease, thalassaemia
Less common but 'important not to miss'
haemolytic anaemias (autoimmune disease, hereditary spherocytosis, G6PD deficiency), coeliac disease, pernicious anaemia, hypothyroidism, haematological malignancies (myelodysplastic syndrome, myelofibrosis, leukaemias, myeloma), metastatic cancer with bone marrow infiltration
haemoglobinopathies, red cell aplasia, aplastic anaemia