A 30 yo female patient presents with symptoms including tiredness, foggy headedness, heavy periods and

A 30 yo female patient presents with symptoms including tiredness, foggy headedness, heavy periods and

frequent colds. She is 170cm tall and weighs 59kg.

Her diet is good and includes red meat 1/7, fish 3/7, tofu / legumes 2/7, fruit 2/day and a good range of

vegetables, but she does not like potatoes. She does eat white rice (basmati) 3 – 4 times a week. Breakfast

is Bircher muesli. Lunch is a mountain bread (whole grain) wrap with egg or tuna and carrots, tomato,

beetroot and lettuce 4 days a week; on Fridays they have pizza or fish and chips at work. She does get

sugar cravings at about 3.30, but tries to eat fruit – Fridays she will give in and have sweet biscuits for
afternoon tea. She does not drink alcohol or soft drinks. She has 3 white coffees a day (no sugar) and one

green tea after dinner. She can’t understand why she feels so rotten, when she is doing all the right things.

The following results of a blood test results are subsequently received from her general practitioner:

Result Reference range

Hb 103g/L 115 – 165

RCC 5.6 x 1012 3.9-5.8

Hct 0.34 0.34-0.47

MCV 64fL 79-99

MCH 20pg 27-34

MCHC 315g/L 320-360

RDW 16.1% 10-17

Plat 273 x109

WBC

Neut 7.6 x109

Lymp 3.3 x109

Mono 0.3 x109

Eos 0.3 x109

Baso 0.1 x109

Other

ESR 100 (0-20)

Ferritin 23mcg/L 15-200

The Laboratory included the following comments:

 Red Cells: Anisocytosis +, Microcytosis ++ Hypochromia ++, Eliptocytosis ++, occasional fragmented cells

 White cells: normal

 Platelets: normal

Specific questions relating to the case study

1. What physical examination could you undertake in clinic that would provide you with additional

information that might clarify this case? (dot points are allowed – you must give a reason for why

you undertake each physical examination to show its relevance to this case)

2. Is there any other information you would like to clarify this case? (dot points are allowed)

3. What complementary tests could be ordered for this patient and why? You should justify the tests

you think are necessary by explaining what information the test would give and how this would

contribute to your diagnosis or differential diagnosis (dot points are allowed – you must give a

reason for why you undertake each physical examination to show its relevance to this case)

4. Provide a probable diagnosis with justification and at least 1 other differential diagnosis

/L 150-400

/L 4 – 11

/L 1-4

/L 0.2-1