Typical exam stem
A patient is found to have haemoglobin 7.8 g/dL. How would you determine the cause of the anaemia?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
How does the reticulocyte count narrow the differential diagnosis?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Start with tempo, severity and physiology
Ask whether the anaemia is acute or chronic, symptomatic or incidental, and whether there is evidence of active bleeding, haemolysis, nutritional deficiency, chronic inflammation, kidney disease or marrow failure. Clinical tolerance depends on both haemoglobin level and the speed at which it fell.
Use MCV as an organiser, not a diagnosis
- Microcytic: iron deficiency, thalassaemia and selected chronic or sideroblastic disorders.
- Normocytic: acute blood loss, haemolysis, renal disease, chronic inflammation and marrow disease.
- Macrocytic: vitamin B12 or folate deficiency, alcohol, liver disease, hypothyroidism, medications and marrow disorders.
- Reticulocyte response separates an appropriate marrow response from underproduction.
Targeted investigations
- Peripheral smear and reticulocyte count.
- Ferritin and iron studies when iron deficiency is possible, interpreted in the context of inflammation.
- B12 and folate when macrocytosis or clinical features suggest deficiency.
- Bilirubin, LDH, haptoglobin and direct antiglobulin testing when haemolysis is suspected.
- Renal, liver and thyroid testing when clinically indicated.
- Investigate the source of iron loss rather than treating iron deficiency as the final diagnosis, especially in men, postmenopausal women or patients with alarm symptoms.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.