Interpreting Blood Results for Anaemia: Understanding the Relationship between Haemoglobin and MCV

When interpreting blood results for anaemia, it is important to understand the relationship between haemoglobin and mean corpuscular volume (MCV). A low haemoglobin and reduced MCV may indicate iron deficiency anaemia secondary to menorrhagia, which is a common cause of microcytosis. Treatment for this would involve managing the underlying menorrhagia and supplementing with iron. On the other hand, a low haemoglobin and raised MCV may indicate macrocytic anaemia, commonly associated with vitamin B12 or folate deficiency. It is important to note that a normal haemoglobin with a reduced MCV or a normal haemoglobin and MCV is unlikely in cases of significant symptoms and abnormal bleeding. Understanding these relationships can aid in the diagnosis and management of anaemia.

AFP Measurement for Detecting Birth Defects and Chromosomal Abnormalities

When a woman is 15 weeks pregnant, a blood test called AFP measurement can be performed to determine if there is an increased risk of certain birth defects and chromosomal abnormalities. This test can detect open neural tube or abdominal wall defects, as well as Down’s syndrome and trisomy 18. In the past, if the results of the AFP measurement were abnormal, an ultrasound scan would be performed. However, it is possible that in the future, mid-trimester anomaly scanning may replace the use of AFP measurement altogether.

Delayed Transfusion Haemolysis: A Possible Cause for Minimal Increase in Haemoglobin

A patient who has received a 3-unit transfusion has only shown a minimal increase in haemoglobin levels, which is a cause for concern. The rise in bilirubin without a corresponding increase in liver enzymes suggests haemolysis from a delayed transfusion haemolysis reaction. This type of reaction occurs when a patient without certain red cell antigens is exposed to these antigens through blood transfusion, resulting in the development of new antibodies and haemolysis after 3-14 days. Symptoms include fevers, rigors, rash, and jaundice, which are less severe and more gradual in onset than acute haemolytic reactions.

Medical management of this patient will involve screening for a wider range of possible antigens and access to a blood bank with a sufficient number of available units for a clean transfusion. Serious complications of blood transfusion are rare due to screening techniques, leukocyte depletion, and improved collection and storage.

Other potential transfusion-related reactions and their approximate time-course include hyperacute (minutes to hours), acute (hours to days), and late (days or longer). Bacterial sepsis is a possible reaction that would occur most likely in the acute time course, but it does not explain the minimal increase in haemoglobin following a 3-unit transfusion. Further haemorrhage, cholestasis of pregnancy, and disseminated intravascular coagulation (DIC) are also unlikely causes.

In conclusion, delayed transfusion haemolysis is a possible cause for the minimal increase in haemoglobin levels in this patient. It is important to consider this reaction and manage it appropriately to prevent further complications.

Blood Donation Guidelines

Blood donation guidelines set by the National Blood Service UK state that individuals who have a family member (parent or sibling) with Creutzfeldt-Jakob disease cannot donate blood. This is due to the risk of transmitting the disease through blood transfusion.

Other factors that may exclude individuals from donating blood include hepatitis or jaundice within the last 12 months, acupuncture within the last four months (unless performed by a registered professional), body piercing or tattoos within the last six months, any infection within the preceding two weeks, or a course of antibiotics within the last seven days.

It is important to follow these guidelines to ensure the safety of both the donor and the recipient. By excluding individuals who may have a higher risk of transmitting diseases or infections, the blood supply can remain safe and effective for those in need of transfusions.

Treatment options for ITP patients

Intravenous immunoglobulin is the preferred treatment for patients with immune thrombocytopenia (ITP) who also have diabetes. Steroids may be used as a trial treatment if the patient does not have any contraindications for steroid-related complications. Platelets are not typically effective in raising platelet counts in ITP patients because they are destroyed by the antibodies. However, they may be used in emergency situations to treat major bleeding. It is important for healthcare providers to carefully consider the individual patient’s medical history and current condition when selecting a treatment plan for ITP. Proper treatment can help manage symptoms and improve quality of life for patients with this condition.

The Effect of Fresh Blood on Haemoglobin Levels

When one unit of fresh blood is transfused, it increases the haemoglobin levels in the body by approximately 10 g/L. This is equivalent to the effect of one unit of red cell concentrate. Both fresh blood and red cell concentrate contain red blood cells, which are responsible for carrying oxygen throughout the body. Therefore, the increase in haemoglobin levels is due to the additional red blood cells that are introduced into the bloodstream. This information is important for medical professionals who need to monitor and manage the haemoglobin levels of their patients, particularly those who have undergone significant blood loss or have conditions that affect their red blood cell count.

Blood Film Abnormalities and Their Significance

Blood film abnormalities can provide important diagnostic information about a patient’s health. One such abnormality is Howell-Jolly bodies, which are nuclear remnants found in red blood cells and indicate hyposplenism. Other abnormalities seen in hyposplenism include target cells, Pappenheimer cells, increased red cell anisocytosis and poikilocytosis, and spherocytes. Patients with hyposplenism are at increased risk of bacterial infections and should be vaccinated accordingly.

Rouleaux formation, on the other hand, is a stack of red blood cells that stick together, forming a rouleau. This occurs in conditions where plasma protein is high, such as multiple myeloma, some infections, Waldenström’s macroglobulinemia, and some cancers.

Schistocytes are irregular and jagged fragments of red blood cells that occur due to mechanical destruction of red blood cells in conditions such as hemolytic anemia. They are not typically seen in hyposplenism.

Tear drop cells, which are seen in conditions where there is abnormality of bone marrow function, such as myelofibrosis, are also not seen in hyposplenism.

Finally, toxic granulation occurs during inflammatory processes such as bacterial infection or sepsis and refers to neutrophils which contain dark, coarse granules. It is not present in hyposplenism.

In summary, understanding blood film abnormalities and their significance can aid in the diagnosis and management of various medical conditions.

Treatment Options for Pernicious Anemia with Hydroxocobalamin

Pernicious anemia is a type of anemia caused by a deficiency in vitamin B12, often due to the presence of anti-intrinsic factor antibodies. Hydroxocobalamin is a form of vitamin B12 that can be used for supplementation in patients with pernicious anemia. Here are some treatment options with hydroxocobalamin:

1. Hydroxocobalamin 1 mg IM three times a week for two weeks, then 1 mg IM every three months: This is the standard dose for patients with pernicious anemia without neurological deficits.

2. Hydroxocobalamin 1 mg IM on alternate days indefinitely: This is used for patients with pernicious anemia and neurological involvement until symptom improvement reaches a plateau, then maintenance involves 1 mg IM every two months.

3. Hydroxocobalamin 1 mg IV three times a week for two weeks, then monthly: This is used for the treatment of cyanide poisoning, not for pernicious anemia.

4. Hydroxocobalamin 1 mg IM three times a week for two weeks, then oral 1 mg hydroxocobalamin: Oral supplementation is not appropriate for patients with pernicious anemia due to absorption issues.

5. Hydroxocobalamin 1 mg subcutaneously three times a week for two weeks, monthly for three months, then 3-monthly: Hydroxocobalamin is administered IM, not subcutaneously.

In conclusion, hydroxocobalamin is an effective treatment option for pernicious anemia, but the dosage and administration route should be carefully considered based on the patient’s individual needs.

Warfarin poisoning is characterized by elevated prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT), along with normal platelet counts. This is due to the drug’s ability to block the function of vitamin K epoxide reductase, leading to a depletion of the reduced form of vitamin K that serves as a cofactor for gamma carboxylation of vitamin-K-dependent coagulation factors. As a result, the vitamin-K-dependent factors cannot function properly, leading to elevated PT and INR, normal or elevated APTT, and normal platelet counts. Thrombocytopenia with normal PT, INR, and APTT can be caused by drugs like methotrexate and carboplatin isotretinoin, which induce direct myelosuppression. Decreased factor VIII levels are seen in haemophilia A, disseminated intravascular coagulation (DIC), and von Willebrand disease, but not in warfarin overdose. Isolated APTT elevation is seen in heparin overdose, while elevated fibrinogen levels can be seen in inflammation, acute coronary syndrome, and stroke, but not in warfarin overdose.

Treatment Options for Hypernatraemia: A Case Study

Hypernatraemia is a condition characterized by an elevated sodium concentration in the blood. In this case study, the patient’s hypernatraemia is mild and caused by insufficient free water intake. It is important to rule out infection as a cause of hypernatraemia, which can increase free water loss. Mild calcification of the aortic arch is a common finding in the elderly and unrelated to the patient’s current complaint.

Hypertonic saline infusion is not recommended as it would further increase the sodium concentration. Standard dialysis is not necessary in this case as the hypernatraemia is not profound enough. 500 ml of 10% dextrose is not appropriate as it is not equivalent to giving free water and is used to reverse hypoglycaemia. 500 ml of 0.9% saline is not the correct option for this patient, but it may be appropriate for hypovolaemic and hypotensive patients to restore circulating volume.

The most appropriate treatment option for this patient is to provide free water, which can be achieved by administering 5% dextrose. It is important to monitor the patient’s sodium levels and fluid intake to prevent further complications. The decision to start hypertonic saline infusion or dialysis should be made by a consultant in severe cases of hypernatraemia.

Understanding Anaemia of Chronic Disease: Increased Ferritin and Decreased TIBC

Anaemia of chronic disease is a type of anaemia that is commonly seen in patients with chronic inflammatory conditions. It is characterised by a low haemoglobin level and low haematocrit, but unlike iron deficiency anaemia, it is associated with increased ferritin levels and decreased total iron-binding capacity (TIBC). This is because ferritin is a serum reactive protein that is elevated in response to the underlying inflammatory process.

Diagnosis of anaemia of chronic disease requires the presence of a chronic inflammatory condition and anaemia, which can be either normocytic or microcytic. It is important to note that a haemoglobin level of <80 g/l is very rarely associated with this type of anaemia. Treatment involves addressing the underlying disorder causing the anaemia and monitoring the haemoglobin level. Blood transfusion is only used in severe cases. It is important to differentiate anaemia of chronic disease from other types of anaemia. For example, it is characterised by a low reticulocyte count, and not reticulocytosis. Serum transferrin receptor is not affected in anaemia of chronic disease and would therefore be normal. Additionally, TIBC is reduced in anaemia of chronic disease, whereas it is increased in iron deficiency anaemia. Finally, anaemia of chronic disease is associated with either microcytosis or normocytosis, whereas macrocytosis is associated with other types of anaemia such as folate deficiency, vitamin B12 deficiency, alcohol excess, and myelodysplastic disease. In summary, understanding the unique features of anaemia of chronic disease, such as increased ferritin and decreased TIBC, can aid in its diagnosis and management.

Citrate Toxicity and Hypocalcaemia in Apheresis Patients

This patient is experiencing symptoms of citrate toxicity, which has led to hypocalcaemia. While it is possible for haemorrhage to occur at the site of venepuncture or venous access, this is typically easy to identify through clinical examination. Sepsis is an uncommon occurrence if proper aseptic precautions have been taken, and the symptoms described here are not indicative of an infection. Immediate treatment is necessary, and this can be achieved by slowing or stopping the apheresis process. Treatment options include the administration of oral or intravenous calcium replacement.

Treatment Options for Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura (TTP) is a medical emergency that requires prompt treatment. The most common initial management for TTP is plasma exchange, which aims to remove the antibodies that block the ADAMTS13 enzyme and replace the ADAMTS13 enzymes in the blood. Intravenous methylprednisone and rituximab may also be used in conjunction with plasma exchange.

Aspirin should only be considered when the platelet count is above 50 × 109/l, and even then, it is not an essential part of initial management and will depend on the patient’s comorbidities. Cryoprecipitate is not recommended for TTP treatment, as it is indicated for disseminated intravascular coagulation or fibrinogen deficiency.

Factor VIII infusion is used for haemophilia A, a C-linked-recessive disorder that presents with excessive bleeding and anaemia, and is less likely to be associated with thrombocytopenia and TTP. Platelet transfusions are relatively contraindicated in TTP and should only be considered in cases of catastrophic bleeding or urgent surgery that cannot wait until after plasma exchange. Platelet transfusions increase the risk of arterial thrombosis, which can lead to myocardial infarction and stroke.

In summary, plasma exchange is the most common initial management for TTP, and other treatment options should be carefully considered based on the patient’s individual circumstances. Early diagnosis and prompt treatment are crucial for a successful outcome.

Comparison of DIC, von Willebrand’s Disease, Liver Failure, Haemophilia, and Heparin Administration

Disseminated intravascular coagulopathy (DIC) is a serious complication of severe sepsis that can lead to multiorgan failure and widespread bleeding. It is characterized by high prothrombin time and the use of fibrinogen for widespread clot formation, resulting in high levels of D-dimer due to intense fibrinolytic activity. DIC is a paradoxical state in which the patient is prone to clotting but also to bleeding.

Von Willebrand’s disease is an inherited disorder of coagulation that is usually autosomal dominant. There is insufficient information to suggest that the patient in this case has von Willebrand’s disease.

Liver failure could result in excessive bleeding due to disruption of liver synthetic function, but there is no other information to support liver failure in this case. Signs of hepatic encephalopathy or jaundice would also be expected.

Haemophilia is an X-linked recessive disorder of coagulation that is characterized by prolonged activated partial thromboplastin time (APTT) and normal prothrombin time.

There is no information to suggest that heparin has been administered, and the bleeding time and platelet count would be normal.

Different Types of Blood Cells and their Progenitor Cells

Blood cells are formed from different types of progenitor cells. The common myeloid progenitor cell gives rise to myeloblasts, pro-erythroblasts, megakaryoblasts, and monoblasts. Myeloblasts produce granulocytes, while pro-erythroblasts produce red blood cells. Megakaryoblasts give rise to megakaryocytes and platelets, and monoblasts produce monocytes that can become tissue-specific macrophages. B cells, NK cells, and T cells are derivatives of the common lymphoid progenitor cell. Plasma cells, which are antibody-secreting cells, are derived from B cells. Understanding the different types of blood cells and their progenitor cells is important for studying blood disorders and developing treatments.

Megaloblastic Anemia and Pernicious Anemia

This patient is suffering from a macrocytic anemia, specifically a megaloblastic anemia, which is characterized by multilobed nuclei. The most probable cause of this condition is a deficiency in vitamin B12, which is commonly associated with pernicious anemia. Pernicious anemia is part of the autoimmune polyendocrine syndrome, which is linked to other autoimmune disorders such as Addison’s disease, type 1 diabetes, Sjögren’s disease, and vitiligo. Although there are other potential causes of macrocytosis, none of them are evident in this patient. Hypothyroidism, for example, does not cause megaloblastic anemia, only macrocytosis.

The appropriate cut-off for determining if iron supplementation is necessary in the postpartum period is <100 g/L. It is important to continue oral iron for three months after normalizing ferritin levels to ensure adequate stores for efficient oxygen delivery to the tissues. Cut-offs of <105 g/L, <110 g/L, and <120 g/L are incorrect for iron supplementation in the second or third trimester of pregnancy, first trimester of pregnancy, and postpartum period, respectively. However, the decision to administer iron for anaemia should be based on the doctor's discretion and the patient's symptoms. During pregnancy, women are checked for anaemia twice – once at the initial booking visit (usually around 8-10 weeks) and again at 28 weeks. The National Institute for Health and Care Excellence (NICE) has set specific cut-off levels to determine if a pregnant woman requires oral iron therapy. These levels are less than 110 g/L in the first trimester, less than 105 g/L in the second and third trimesters, and less than 100 g/L postpartum. If a woman’s iron levels fall below these cut-offs, she will be prescribed oral ferrous sulfate or ferrous fumarate. It is important to continue this treatment for at least three months after the iron deficiency has been corrected to allow the body to replenish its iron stores. By following these guidelines, healthcare professionals can help ensure that pregnant women receive the appropriate care to prevent and manage anaemia during pregnancy.

Blood Groups

Blood groups are determined by the presence or absence of certain antigens on the surface of red blood cells and the corresponding antibodies in the plasma. Blood Group O has no A or B antigens on the red cells and has both anti-A and anti-B antibodies in the plasma. Blood Group AB has both A and B antigens on the red cells but no antibodies in the plasma. Blood Group A has only A antigens on the red cells and anti-B antibodies in the plasma. Blood Group B has only B antigens on the red cells and anti-A antibodies in the plasma. It is important to know your blood group for medical purposes, such as blood transfusions, as incompatible blood types can cause serious health complications.

Diagnosis and Associated Risks of Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is diagnosed when there is evidence of at least two out of three features, with other potential causes excluded. These features include oligoamenorrhoea, elevated levels of total/free testosterone (or clinical features suggestive of hyperandrogenism), or the presence of polycystic ovaries on ultrasound. While an extremely marked elevation in testosterone can suggest an androgen-secreting tumor, this is rare. Additionally, raised luteinising hormone (LH) with a normal follicle-stimulating hormone (FSH) can lead to an elevated LH/FSH ratio, but this is not diagnostic.

PCOS is associated with an increased risk of impaired glucose tolerance, although this may take a number of years to become apparent. Furthermore, there may be a reduction in levels of oestriol, although this is not always a consistent finding. It is important to diagnose PCOS early on to manage the associated risks and prevent potential complications.

Diagnostic Investigations for Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma is a type of cancer that affects the lymphatic system. There are several diagnostic investigations that can be used to diagnose this condition.

Excisional Biopsy of an Enlarged Lymph Node: This is the most common diagnostic investigation for suspected non-Hodgkin’s lymphoma. It involves removing all of the abnormal tissue from an enlarged lymph node.

Computed Tomography (CT) of the Chest, Neck, Abdomen, and Pelvis: CT scanning can indicate features suggestive of lymphoma, such as lymphadenopathy and hepatosplenomegaly. However, it cannot provide a tissue diagnosis.

Core Needle Biopsy of an Enlarged Lymph Node: If a surgical excisional biopsy is not appropriate, a core needle biopsy can be performed. However, if this does not reveal a definite diagnosis, then an excisional biopsy should be undertaken.

Full Blood Count: A full blood count can be a helpful first-line investigation if a haematological malignancy is suspected, but it is not sufficient to be diagnostic for non-Hodgkin’s lymphoma.

Protein Electrophoresis and Urine Bence-Jones Protein: Protein electrophoresis can be helpful in screening for multiple myeloma, but it is not helpful for diagnosing non-Hodgkin’s lymphoma.

In conclusion, a combination of these diagnostic investigations can be used to diagnose non-Hodgkin’s lymphoma. However, excisional biopsy remains the gold standard for diagnosis.

Microcytic Hypochromic Anaemia and the Importance of Blood Transfusion

This patient is presenting with a microcytic hypochromic anaemia, which is commonly caused by iron deficiency due to occult gastrointestinal (GI) blood loss in a Caucasian population. To determine the cause of the anaemia, a full history and examination should be conducted to look for clues of GI blood loss. Given the microcytic hypochromic picture, it is likely that blood loss has been ongoing for some time.

Although there is no evidence of haemodynamic compromise or congestive cardiac failure (CCF), the patient is experiencing breathlessness on minimal exertion. This justifies an upfront transfusion to prevent the patient from going into obvious cardiorespiratory failure. At a Hb of 64 g/L in a 72-year-old, the benefits of transfusion outweigh the risks.

While haematinics such as ferritin, vitamin B12, and folate are important investigations, the most crucial management step is organising a blood transfusion. This will help to address the immediate issue of anaemia and prevent further complications.

Preparation of Plasma Derivatives

The preparation of plasma derivatives, such as factor VIII, involves pooling several thousand plasma donations, typically 20,000 or 5,000 kg of plasma at a time. To avoid the risk of vCJD, pooled plasma has been sourced from outside the UK since 1999. The process includes several chemical steps, including ethanol extraction, chromatography, and viral inactivation, resulting in a freeze-dried product. These products have a long shelf life of several months to years.

Understanding Antiphospholipid Syndrome (APLS) and its Link to Recurrent Spontaneous Abortions

When a young woman experiences multiple spontaneous abortions, it may indicate an underlying disorder. One possible cause is antiphospholipid syndrome (APLS), a hypercoagulable state with autoantibodies against phospholipid components. This disorder can lead to recurrent spontaneous abortions during the first 20 weeks of pregnancy, and approximately 9% of APLS patients also have renal abnormalities.

Other potential causes of recurrent spontaneous abortions include poorly controlled diabetes, nephritic syndrome, dermatomyositis, and anatomic defects like a bicornuate uterus. However, the examination and test results in this case suggest a systemic etiology, making APLS a strong possibility.

Diagnosing systemic lupus erythematosus (SLE), which can also cause nephritic or nephrotic syndrome, requires meeting at least 4 out of 11 criteria established by the American Rheumatism Association (ARA).

Understanding these potential causes and their links to recurrent spontaneous abortions can help healthcare providers identify and treat underlying disorders in women of reproductive age.

Management of Refractory Platelet Transfusions

Patients who do not respond to platelet transfusions should be evaluated to ensure that their platelet counts are increasing adequately. The best way to do this is by taking a blood sample one or two hours after the transfusion. If the patient’s platelet counts are still low, further investigation is necessary. However, it is not appropriate to request HLA-matched platelets or a directed platelet donation at this stage.

Continuing to give random platelet transfusions is also not recommended. Platelets are necessary for the patient’s recovery, but it is important to determine why the transfusions are not working. Therefore, checking for HLA antibodies is the next step in the management of refractory platelet transfusions. Once the cause of the refractory response is identified, appropriate treatment can be initiated.

In summary, managing refractory platelet transfusions involves evaluating the patient’s response to the transfusions, checking for HLA antibodies, and determining the underlying cause of the refractory response. Platelets are still necessary for the patient’s recovery, but it is important to address the underlying issue to ensure that the transfusions are effective.

Paroxysmal Nocturnal Haemoglobinuria: A Clonal Defect of Red Cells

Paroxysmal nocturnal haemoglobinuria (PNH) is a condition where red blood cells have an increased susceptibility to lysis by complement due to an acquired clonal defect. This disorder typically presents in young adults and is often associated with other stem cell disorders, such as aplastic anaemia. The classic symptom of PNH is the intermittent passage of bloody urine, which tends to occur more frequently at night for unknown reasons. Diagnosis is often made through investigation of anaemia, pancytopenia, or recurrent thrombotic episodes, which are likely caused by complement-induced platelet aggregation. Flow cytometry can confirm the diagnosis by demonstrating a lack of erythrocyte membrane proteins CD59 and decay accelerating factor (DAF).

Overall, PNH is a rare but serious condition that can lead to significant complications if left untreated. Early diagnosis and management are crucial for improving outcomes and preventing further damage to the body.

The Role of Hormone Assays in Confirming Pregnancy

Beta-HCG is a hormone produced by the placenta during pregnancy. There are highly sensitive assays available to detect the presence of beta-HCG, which can confirm pregnancy. In fact, some manufacturers of pregnancy tests claim that their tests are more accurate than ultrasound dating in determining gestation during the early stages of pregnancy.

While alpha-fetoprotein may also be elevated in pregnancy, particularly in cases of neural tube defects, it is not the primary focus of pregnancy testing. Hormone assays for oestrogen, progesterone, or testosterone levels are not reliable methods for confirming pregnancy. Therefore, beta-HCG remains the most reliable hormone to test for when confirming pregnancy.

It is important to note that while hormone assays can confirm pregnancy, they cannot determine the viability of the pregnancy or the presence of any complications. Ultrasound imaging and other diagnostic tests may be necessary to assess the health of the pregnancy and the developing fetus.

The patient is presenting with thrombotic thrombocytopenic purpura (TTP), which is characterized by low platelet count due to clotting and platelet sequestration in small vessels. TTP is associated with haemolytic anaemia, thrombocytopenic purpura, fever, and neurological and renal abnormalities. The patient’s risk factors for TTP include being female, obese, pregnant, and of Afro-Caribbean origin. To determine the appropriate management, a urinary β-hCG test should be performed to establish pregnancy status. The first-line treatment for TTP is plasma exchange with fresh frozen plasma. Blood cultures should also be performed to check for underlying septicaemia. Antiplatelet antibody titres can be raised in idiopathic thrombocytopenic purpura (ITP), but ITP does not cause renal failure. A bone marrow study is appropriate to rule out leukaemia. Illicit drug use should also be considered as a cause of disseminated intravascular coagulation (DIC).

Delayed Grief Reaction and Elevated MCV in a Patient

Explanation:
The patient in question is displaying a delayed grief reaction following the recent death of her husband. Her FBC shows a normal picture except for an elevated MCV, which suggests alcohol excess. If the cause of macrocytosis were folate or B12 deficiency, it would be expected to cause anemia in association with the macrocytosis. Hypothyroidism may also cause macrocytosis, but the patient’s weight loss argues against this diagnosis. For further information on macrocytosis, refer to the BMJ Practice article Macrocytosis: pitfalls in testing and summary of guidance, the BMJ Endgames case report A woman with macrocytic anemia and confusion, and the BMJ Best Practice article Assessment of anemia.

Hydatidiform Mole and Trophoblastic Disease

A hydatidiform mole is a type of abnormal pregnancy that only generates placental tissue. However, approximately 10% of cases of hydatidiform mole can transform into malignant trophoblastic disease. To assess if there is any retained tissue or recurrence/malignant transformation, the best way is to measure the levels of HCG, which is primarily produced by the placenta. On the other hand, alpha-fetoprotein, CEA, and CA-125 are tumour markers associated with hepatocellular carcinoma, colonic carcinoma, and ovarian carcinoma, respectively. It is important to note that progesterone levels are not useful in determining the prognosis of trophoblastic disease. the characteristics and markers of hydatidiform mole and trophoblastic disease is crucial in the diagnosis and management of these conditions.

An acute haemolytic reaction is a transfusion complication that can occur within 24 hours of receiving blood. It is often caused by ABO/Rh incompatibility and can result in symptoms such as agitation, fever, low blood pressure, flushing, pain in the abdomen or chest, bleeding from the site of the venepuncture, and disseminated intravascular coagulation (DIC). Treatment involves stopping the transfusion immediately. Iron overload, hepatitis B infection, graft-versus-host disease (GvHD), and human immunodeficiency virus (HIV) infection are all delayed transfusion reactions that may present after 24 hours.