Welcome back to #teamhaem!

This case starts in general practice.  A 55 year old gentleman presents feeling tired and short of breath.  He states that over the past few weeks he has became increasingly fatigued and can no longer walk to the shops.  His family have stated he looks peaky.  There has been no cough or sputum adn his chest is clear on examination.  He looks pale.  He has a past medical history of ischaemic heart disease, having suffered a non-ST-segment elevation myocardial infarction the year previous.  He has two drug eluting stents placed nine months previously.  He also has hypertension, diet controlled type II diabetes mellitus, rheumatoid arthritis and is an ex smoker.

A full blood count is performed:

Hb 79g/L

WCC 9.8×10*9/L

MCV 103fL

Neuts 4.5×10*9/L

lymphs 3.5×10*9/L

PLT 167×10*9/L

U&E and bone profile are normal.

Questions:

• What are your differential diagnoses of a macrocytic anaemia?
• Now you have the bloods back, what do you do?  Does the patient need admission?

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