Sat27November0556PM 28

A 20-year-old man is admitted to the medical assessment unit with left leg and abdominal pain and lethargy. He has a history of sickle cell disease.

The pain is uncontrolled despite a combination of paracetamol, codeine and diclofenac which he has been taking at home.

Observations are:

Temperature 38.5°C

HR 105

BP 110/75 mmHg

Respiratory rate 20

A full blood count is taken:

Hb 54 g/L (130-180)

WCC 12.5 ×109/L (4-11)

Platelets 356 ×109/L (150-400)

MCV 89 fL (80-96)

Neutrophils 9.5 ×109/L (1.5-7.0)

Reticulocyte count 16 ×109/L (25-85)

What is the most likely cause of the anaemia?

(Please select 1 option)

B12 deficiency

Acute haemolytic crisis Incorrect answer selected

Parvovirus infection This is the correct answer

GI bleeding

Splenic sequestration

Explanation

Parvovirus infection can cause severe anaemia in patients with haemolytic diseases due to a decrease in erythropoiesis leading to an aplastic crisis. The clue is the low reticulocyte count.

Acute haemolytic crisis, GI bleeding and splenic sequestration would usually be associated with a raised reticuloctye count.

B12 deficiency would be associated with a raised MCV.

The pyrexia is likely caused by parvovirus infection.

Answer Statistics

1

1%

2

46%

3

29%

4

2%

5

25%

Times answered: 291