Monday (E) 4 hr A 45 yr old mother of five came to a clinic with the complaint of tiredness on exertion.

She also suffered from palpitation. She looks pale. A. What will you do? History Taking Examination: Inspection, Palpation, Percussion and Auscultation -------? Clinicians B. Laboratory investigations: What laboratory test would you like to order? Blood for complete picture: RBC, Hb, MCV, MCHC, MCH, Hct, WBC (total and differential), Ptt ESR B.1. What information do they give? B.2. What is their normal value? B.3. What do you think of the values of these tests in that woman? C. On investigation, her haemoglobin concentration is 8 G/dL, Hct 38%, ESR 15 mm after 1st hour, total WBC count 11,000/l, neutrophil 60% and lymphocytes 25%. Platelet count is normal. C.1. What do these results point to? C.2. Explain the reasons? C.3. How would you proceed? Any more tests required?

D. She gave a history of postpartum haemorrhage during the delivery of her baby. She never took iron containing drugs. D.1. What is the possible cause of anaemia in her case? D.2. Do you want to ask her about her diet? If yes, what will you ask and for what? D.3. Does her lactation habit influence the development of anaemia ? D.4. What kind of food would you recommend her to take? D.5. How would you know her iron supplementation needs? How much iron would be needed to correct iron deficiency? D.6. How would you differentiate anaemia due to iron deficiency and haemolysis?

D.7. Does she need to receive erythropoietin injection? Or testosterone? Give reasons. D.8. What else would you see if there is bone marrow depression?

E. Why should anaemia be corrected? F. What are the consequences if anaemia becomes chronic? G. Is blood transfusion needed in the above women? Give reason for your answer. H. Will you ask her to come back for follow up? Would you like to refer her to the hospital?