Fatigue with borderline bloods — CCE clinical encounter

CCE-style clinical encounter: a 41-year-old vegetarian woman with fatigue, heavy periods and microcytic bloods wants 'just iron tablets'. The candidate must apply the MCV framework, check the Mentzer index, interpret iron studies correctly, start alternate-day iron with menstrual-cause management, and set review expectations.

clinical encounter with role-player (CCE format)2 min readVerification in progress

Prompt

A 41-year-old teacher attends exhausted. Heavy periods for two years (8 days, hourly changes on day 2). Vegetarian 15 years. Hb 112 g/L, MCV 72 fL, ferritin 9 µg/L, RBC 5.9 x10^12/L. Her sister has beta-thalassaemia trait and told her iron is dangerous.

Objectives

Diagnose iron-deficiency anaemia using the MCV/ferritin pattern and explain why it fits despite family history. ^[6] ^[13]
Address the thalassaemia concern with Mentzer index reasoning and confirmatory-test logic. ^[6]
Prescribe oral iron correctly — alternate-day dosing rationale — and counsel on absorption optimisation. ^[5]
Identify and manage the menstrual driver rather than replacing iron indefinitely. ^[6]
Set review expectations: response at 8–12 weeks, continue three months after normalisation, safety-net GI symptoms. ^[5]

References5Show

[1]Braat S, Fielding KL, Han J et al. Haemoglobin thresholds to define anaemia from age 6 months to 65 years: estimates from international data sources. The Lancet. Haematology, 2024.PMID 38432242
[4]Jairath V, Kahan BC, Gray A et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER). Lancet, 2015.PMID 25956718
[5]von Siebenthal HK, Gessler S, Vallelian F et al. Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. EClinicalMedicine, 2023.PMID 38021373
[6]Kumar A, Saha D, Kini J et al. The role of discriminant functions in screening beta thalassemia trait and iron deficiency anemia among laboratory samples. Journal of laboratory physicians, 2017.PMID 28706390
[13]Bamrah D, Nautiyal R, Kala M et al. Screening for β-Thalassemia Trait in Pregnant Women With Microcytic Hypochromic Anemia and Its Impact on Pregnancy Outcomes. Cureus, 2026.PMID 42245877

Fatigue with borderline bloods — CCE clinical encounter

clinical encounter with role-player (CCE format)2 min readVerification in progress

Objectives

Diagnose iron-deficiency anaemia using the MCV/ferritin pattern and explain why it fits despite family history. ^[6] ^[13]

Address the thalassaemia concern with Mentzer index reasoning and confirmatory-test logic. ^[6]

Prescribe oral iron correctly — alternate-day dosing rationale — and counsel on absorption optimisation. ^[5]

Identify and manage the menstrual driver rather than replacing iron indefinitely. ^[6]

Set review expectations: response at 8–12 weeks, continue three months after normalisation, safety-net GI symptoms. ^[5]

References5Show

[1]Braat S, Fielding KL, Han J et al. Haemoglobin thresholds to define anaemia from age 6 months to 65 years: estimates from international data sources. The Lancet. Haematology, 2024.PMID 38432242
[4]Jairath V, Kahan BC, Gray A et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER). Lancet, 2015.PMID 25956718
[5]von Siebenthal HK, Gessler S, Vallelian F et al. Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. EClinicalMedicine, 2023.PMID 38021373
[6]Kumar A, Saha D, Kini J et al. The role of discriminant functions in screening beta thalassemia trait and iron deficiency anemia among laboratory samples. Journal of laboratory physicians, 2017.PMID 28706390
[13]Bamrah D, Nautiyal R, Kala M et al. Screening for β-Thalassemia Trait in Pregnant Women With Microcytic Hypochromic Anemia and Its Impact on Pregnancy Outcomes. Cureus, 2026.PMID 42245877