In the investigation of blood diseases, the simplest test is a full blood count (FBC). A full blood count measures the following in a sample of blood:
• the amount of haemoglobin
• the number of the different cells – red blood cells (erythrocytes), white blood cells (leucocytes) and platelets (thrombocytes)
• the volume of the cells
• the erythrocyte sedimentation rate (ESR) – a measurement of how quickly red blood cells fall to the bottom of a sample of blood.
Anaemia is one of the commonest diseases of the blood. It may be due to:
• bleeding – loss of blood
• excessive destruction of red cells
• low production, for example because the diet is lacking, or deficient in, iron (Fe).
A medical student has examined an elderly patient with a very low level of haemoglobin and is discussing the case with her professor:
Professor: What’s the most likely diagnosis in this case?
Student: Most probably carcinoma of the bowel with chronic blood loss. What’s
Professor: against that as a diagnosis?
Student: Well, he hasn’t had any change in his bowel habit, or lost weight.
Professor: What else would you include in the differential diagnosis of severe anaemia in a man of this age?
Student: He might have leukaemia of some sort, or aplastic anaemia, but that’s rare – it would be very unusual. Another cause is iron deficiency, but he seems to have an adequate diet.
Professor: OK. Now, there’s another cause of anaemia which I think is more likely.
Student: Chronic bleeding ulcer?
Professor: Yes, that’s right. But what about pernicious anaemia? Can you exclude that?
Student: Well, he’s got none of the typical neurological symptoms, like paraesthesiae.
Jordi Pons, the medical student from Barcelona, has made some language notes in his textbook.
icious anaemia (PA) is a condition in which there phy of the gastric mucosa with consequent failure of i intrinsic factor production and vitamin 812 malabsorption. 1 The onset is insidious, with progressively increasing ‘ symptoms of anaemia.