IM9.1-17 | Anaemia — Assignment

CLINICAL SCENARIO

This assignment requires you to produce a structured clinical case report and management plan for a patient with anaemia, based on a case scenario provided by your faculty or drawn from your clinical posting. You will demonstrate competency in structured history-taking, systematic physical examination, interpretation of iron studies and other investigations, evidence-based management prescribing, and patient-centred communication. The case report should reflect the integrated diagnostic approach taught in the Anaemia SDLs — classification by MCV and reticulocyte count, iron studies pattern interpretation, and cause-specific treatment.

Section 1: Structured Clinical History

Guidance: Document the clinical history of your anaemia patient using the seven-domain framework: (1) onset and course of symptoms; (2) dietary history (vegetarian/non-vegetarian, tea/coffee intake, caloric adequacy); (3) blood loss (GI symptoms, menstrual history — duration, cycle length, clots, intermenstrual bleeding, number of pads/day); (4) obstetric and reproductive history; (5) prior anaemia diagnosis and treatment (response to previous iron, B12, or folate); (6) medications (NSAIDs, PPIs, methotrexate, anticonvulsants); (7) family and ethnic background (thalassaemia, sickle cell, G6PD in family; tribal or coastal origin). For each domain, explicitly state how the finding supports or argues against a specific anaemia aetiology. Approximately 300 words.

Section 2: Physical Examination

Guidance: Document the systematic physical examination. (a) Pallor: assess and grade at all four sites — palpebral conjunctivae, palmar creases, tongue, and nail beds. State which sites showed pallor and which did not. (b) Hyperdynamic circulation: document heart rate, bounding pulse, capillary refill, and any cardiac flow murmur. (c) Aetiology-specific signs: state whether the following are present or absent for EACH of the following signs, and for those present, state their diagnostic significance: koilonychia, glossitis, angular stomatitis, jaundice, lymphadenopathy, hepatosplenomegaly, bone tenderness, neurological findings (vibration/proprioception). Approximately 250 words.

Section 3: Investigation Interpretation and Differential Diagnosis

Guidance: Interpret the investigations provided (CBC/haemogram, MCV, RDW, reticulocyte count, peripheral smear, iron studies — ferritin, TIBC, serum iron, transferrin saturation, and any additional tests performed). For iron studies: state the values, the normal ranges you are applying, and identify which pattern is present (IDA, ACD, thalassaemia trait, or mixed). Construct a ranked differential diagnosis of at least three possibilities, stating your pre-test probability for each and the specific finding that most strongly supports or argues against it. Approximately 250 words.

Section 4: Evidence-Based Management Plan

Guidance: Write a complete management plan: (a) Cause-specific treatment: state the drug, preparation, dose, route, timing (e.g., before meals with vitamin C), and duration. For IDA: specify elemental iron content of the preparation chosen. State when to reassess and what response you expect (Hb rise per month). (b) Transfusion decision: state whether a transfusion is indicated, applying the restrictive threshold (Hb < 7 g/dL for stable, or < 8 g/dL with symptoms/cardiovascular risk). If indicated, state the component and target Hb. (c) Prevention: is the patient eligible for any national programme (AMB, WIFS, antenatal IFA supplementation)? (d) Specialist referral indication: state the trigger for haematology/gastroenterology referral. Approximately 250 words.

Section 5: Patient Communication and Counselling

Guidance: Write a concise communication plan directed at your specific patient. Include: (a) How you would explain the diagnosis in plain language appropriate to the patient's education and language background; (b) Instructions for iron tablets: when to take them, what to expect (black stools, possible GI discomfort), what to avoid (tea, coffee, antacids within 2 hours), and why the course must be completed even after feeling better; (c) Dietary advice: name at least three iron-rich foods relevant to the patient's dietary preference (vegetarian-appropriate if applicable); (d) When to return urgently. Approximately 200 words.

Section 6: Reflection

Guidance: In 100-150 words, reflect on ONE specific decision point in this case where a systematic diagnostic approach — using MCV, reticulocyte count, or iron studies — either changed your management or prevented an error. For example: how would you have managed this patient if you had simply prescribed iron empirically without investigations? What error or harm might have resulted? Approximately 150 words.

PEER REVIEW

Review your peer's case report using the rubric provided. For each of the six sections, assign a score and write one specific comment — do not copy the rubric descriptor. Specifically check: (1) Section 3 — does the student correctly distinguish the iron studies pattern, and is the Mentzer index (MCV/RBC) used if thalassaemia trait is in the differential? (2) Section 4 — is the transfusion threshold correct (restrictive strategy, not liberal)? Is the iron dose stated with elemental iron content? Is treatment duration continued after Hb normalisation? (3) Section 5 — is the dietary advice India-appropriate and vegetarian-friendly? Submit your peer review within 72 hours.