BOF: 20
A 45-year-old female being treated for rheumatoid
arthritis is admitted complaining of breathlessness on exertion. She is found to
have a Haemoglobin level of 8.5 g/dl with a MCV of 102.
The white cell count and platelets are normal.
The anaemia is most likely to be due to:
a)
Treatment with Diclofenac
b)
Treatment with methotrexate
c)
Anaemia of chronic disease
d)
Treatment with penicillamine
e)
Felty’s syndrome
Answer:
d)
Treatment with non-steroidal anti-inflammatory drugs
would result in anaemia as a consequence of gastro-intestinal haemorrhage. This
would cause a microcytic hypochromic anaemia if chronic or normocytic
normochromic anaemia if acute.
Methotrexate treatment would result in marrow aplasia
and a pancytopaenia
Anaemia of chronic disease would result in normocytic
normochromic anaemia.
In Felty’s syndrome the patient would be neutropaenic.
Treatment with penicillamine could result in haemolytic
anaemia with macrocytosis
Revision Tip
Revise rheumatoid arthritis KEYS
to SUCCESS in Medicine page 503-505
