Anaemia: pattern-based investigation — structured viva

Structured oral on anaemia: defending the MCV-based pattern framework, interpreting iron studies under inflammation confounding, separating thalassaemia trait from iron deficiency, working up macrocytosis and haemolysis, explaining hepcidin logic in ACD, and defending restrictive transfusion thresholds.

Prompt

The examiner opens: 'Your registrar says anaemia is just iron tablets and a colonoscopy. Teach them the framework in five minutes.' The viva branches through thresholds, MCV classification, iron-study interpretation, thalassaemia discrimination, macrocytosis, haemolysis, ACD hepcidin logic, and restrictive transfusion.

Stem

You are the GP. The registrar has five abnormal blood counts on their desk and one question: where do I start? ^[14]

References10Show

[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
[3]Mazer CD, Whitlock RP, Fergusson DA et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. The New England journal of medicine, 2017.PMID 29130845
[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
[7]Kaferle J, Strzoda CE Evaluation of macrocytosis. American family physician, 2009.PMID 19202968
[9]Abbotts K, Sriskandarajah P Anemia of Chronic Disease: Pathophysiology, Diagnosis and Management. Hematology reports, 2026.PMID 42496447
[11]Sultana N, Bajwa FA, Sikandar MZ et al. Effect of iron therapy on fatigue symptoms in non-anaemic iron deficient women of reproductive age- A Randomized Controlled Trial. JPMA, 2026.PMID 41736325
[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
[14]Shao J, Zhang Y, Lin W et al. Restrictive versus liberal red blood cell transfusion strategies for cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Journal of cardiothoracic surgery, 2026.PMID 42021257

Anaemia: pattern-based investigation — structured viva

Stem

You are the GP. The registrar has five abnormal blood counts on their desk and one question: where do I start? ^[14]

References10Show

[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
[3]Mazer CD, Whitlock RP, Fergusson DA et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. The New England journal of medicine, 2017.PMID 29130845
[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
[7]Kaferle J, Strzoda CE Evaluation of macrocytosis. American family physician, 2009.PMID 19202968
[9]Abbotts K, Sriskandarajah P Anemia of Chronic Disease: Pathophysiology, Diagnosis and Management. Hematology reports, 2026.PMID 42496447
[11]Sultana N, Bajwa FA, Sikandar MZ et al. Effect of iron therapy on fatigue symptoms in non-anaemic iron deficient women of reproductive age- A Randomized Controlled Trial. JPMA, 2026.PMID 41736325
[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
[14]Shao J, Zhang Y, Lin W et al. Restrictive versus liberal red blood cell transfusion strategies for cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Journal of cardiothoracic surgery, 2026.PMID 42021257