Case 17 – the beginning

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.


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

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

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