Our team wondered whether this was an ‘anaemia of chronic disease’ e.g. due to an inflammatory state. Investigations from the GP showed CRP 8mg/L (normal <5), ESR 67mm/Hr. The patient was previously investigated for a peripheral neuropathy and had B12 and folate recently which were well within the normal ranges. A blood film is reported as: “no megaloblastic or dysplastic features, no abnormal infiltrate”.

On reviewing the patient’s history there was no blood loss or abnormal bleeding except for occasional nose bleeds which were not thought to be serious. She was relatively independent until four months ago when she started to fall and developed increasing ankle oedema resulting increased diuretic use.  She has lost weight since an increase in diuretics and is short of breath.

Questions:

• How do you investigate the anaemia further?
• Do you refer for endoscopy?
• What do you think of the ‘falls’?

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