October 17, 2010

PLAB Question 15

MCV: Decreased Serum ferritin: Increased Total iron binding capacity: Normal Serum iron: Increased Marrow iron: Present

a) Thalassaemia trait
b) Hypoparathyroidism
c) Hereditary sideroblastic anaemia
d) Protein energy malnutrition
e) Chronic renal failure
f) Anaemia of chronic disease
g) Acute blood loss
h) Iron deficiency anaemia
i) Oral contraceptives
j) Megaloblastic anaemia

The correct answer is C

Patients with a defect in mitochondrial function resulting in a sideroblastic anaemia can also present with a microcytic, hypochromic anaemia. Hereditary sideroblastic anaemia is a rare condition that presents in childhood either as an X-linked or autosomally inherited condition.

Red blood cell morphology is typically dimorphic, and measurements of iron supply make the distinction from iron deficiency quite easy. Table (click and then see below).

Patients who develop an acquired ringed sideroblastic anaemia typically exhibit excessive iron accumulation, even to the point of tissue iron overload. Their red blood cell morphology can be quite variable, while marrow morphology demonstrates the pathognomonic finding of ringed sideroblasts

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