MBBS OSCE · Haematology / General Medicine
OSCE — iron-deficiency anaemia assessment and treatment
OSCE on classifying microcytic anaemia, iron studies interpretation, oral iron dosing, when to use IV iron/transfusion thresholds, and mandatory GI investigation of IDA in men and postmenopausal women.
8 min stationSource-verified ·
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Exam tags
NEET-PGINICETUSMLEPLAB
Brief (to candidate)
A 28-year-old woman with menorrhagia has fatigue, pagophagia, and koilonychia. Hb 72 g/L, MCV 68, ferritin 8 µg/L, high TIBC. Assess and treat in 8 minutes. Also state approach if this were a 65-year-old man with the same iron studies. [1]
Candidate instructions
- Diagnose iron-deficiency anaemia; interpret iron panel vs ACD. [1]
- Examine for glossitis, angular cheilitis, koilonychia, cardiac flow murmur.
- Treat cause (menorrhagia) + ferrous sulphate 200 mg TDS (or OD regimens per tolerability) for months after Hb normalises.
- Response timeline: reticulocytosis 7–10 days; Hb rise ~10 g/L per 2 weeks. [1]
- IV iron if intolerant/need rapid repletion; transfusion only if unstable or severe symptomatic anaemia per thresholds (~70 g/L restrictive in many settings).
- Male/postmenopausal IDA → bidirectional GI endoscopy to exclude cancer (especially right colon/gastric).
Examiner checklist
| Domain | Expected |
|---|---|
| Classification | Microcytic differential: Fe def, thal trait, ACD, sideroblastic |
| Labs | Low ferritin/Fe, high TIBC, low TSAT |
| Oral iron | Dose, duration, absorption advice (vit C; avoid tea/calcium co-admin) |
| Cause | Gynae + diet; always seek bleeding source when indicated |
| Red flag | IDA man/postmenopausal woman = GI work-up |
| Special | Pregnancy iron needs; B12/folate if mixed picture |
Common errors
- Transfusing stable young woman with Hb 72 without iron trial. [1]
- Stopping iron when Hb normalises (stores not replete).
- Missing colonoscopy indication in older/male IDA.
Model key actions
- Microcytic + low ferritin/high TIBC = iron deficiency, not thalassaemia trait alone. [1]
- Ferrous sulphate about 200 mg TDS (or alternate-day if intolerant) continued 3 months after Hb normalises.
- Expect reticulocytosis by day 7 to 10; investigate non-response.
- Men and postmenopausal women with IDA need GI investigation for occult malignancy.
Common errors
- Transfusing compensated outpatient IDA without iron therapy trial. [1]
- Using ferritin alone in inflammation without clinical context.
- Stopping iron the day Hb normalises.
References3ShowHide
- [1]Goddard AF, James MW, McIntyre AS, Scott BB; British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut, 2011.PMID 21561874
- [2]Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol, 2017.PMID 29032957
- [3]Weiss G, Ganz T, Goodnough LT Anemia of inflammation. Blood, 2019.PMID 30401705