A 

normal range for red cell distribution width is 12.2 to 16.1 percent in adult females and
11.8 to 14.5 percent in adult males.

The normal reference range for ESR results is 1–13 mm/hr for males and 1–20 mm/hr for
females.

1
If the RPI is <2 in the presence of established anaemia it indicates a defect in erythroid proliferation or maturation.

2
A 20 year old male of Greek origin presents with a 3 day history of pallor and dark urine. He was
about to go to Kenya on holiday. In his family history a brother had a similar episode some years
ago following a course of co-trimoxazole. On examination apart from pallor there is nothing to
find. Hb 5.5 gm/dl, MCV 105 fl, MCH 27 pg, MCHC 36 g/dl, WCC 8.5 x 10 9/l with normal
differential count, platelets 425 x 109/l, reticulocytes 196 x 109/l (normal (50-100), urea 3.5
mmol/l, creatinine 70mmol/l, Na 138 mmol/l, K 4 mmol/l, AST 31 U/l, ALT 27 U/l, ALP 100 U/l,
bilirubin 75 μmol/l, LDH 1250 U/l. His blood film shows blister cells. Which one of the following
is the most likely diagnosis?

Aplastic anaemia

Autoimmune haemolytic anaemia

Glucose 6 phosphatase dehydrogenase deficiency

Hepatitis B

Hereditary spherocytosis

A 30 year old chronic schizophrenic patient is found in a collapsed state. He is unable to give
history but information states that he is taking clozapine, codeine, diazepam, nitrazepam, and
paracetamol. On examination his temperature is 39.5 °C, pulse 100/min, BP 80/40 mmHg. There
was nothing else of note on examination. Hb 12.5 gm/dl, WCC 0.5 x 10 9/l with neutrophils 0.2 x
109/l, platelets 220 x 109/l, reticulocytes 64 x 109/l (normal (50-100), PT 13 secs (normal 12-17
secs), aPTT 27 secs (normal 24-38), TT 17 secs (normal 14-22), fibrinogen 3.2 g/l (normal 2-5).
Which one of the following is the most likely cause of his neutropenia?

Acute myeloid leukaemia

Autoimmune neutropenia

Clozapine

Nitrazepam

Septicemia

3
A 20 year old African refugee presents with sudden onset of a dense right sided hemiparesis. He
speaks little English but from friends it appears that he has no previous medical history of note
but 2 siblings died in infancy. On examination he has a right hemiparesis and 3 cms
splenomegaly. On investigation his Hb 8.5 gm/dl, MCV 102 fl, MCH 33 pg, MCHC 32.5 g/dl, WCC
12.5 x 109/l with neutrophilic leukocytosis, platelets 120 x 10 9/l, reticulocytes 220 x 109/l (normal
50-100), urea 3.5 mmol/l, creatinine 70 mmol/l, Na 140 mmol/l, K 4 mmol/l, AST 30 U/l, ALT 62
U/l, ALP 52 U/l, bilirubin 55 μmol/l, LDH 1128 U/l. His blood shows numerous sickled cells.
Which one of the following is the most important immediate management of his condition?

Immediate exchange transfusion

IV antibiotics

Pain relief

Rehydration

Top-up transfusion

A 9 year old girl is brought to her GP. Her mother has noticed that she appears jaundiced. She is
feeling very tired. This has happened intermittently on several occasions. On examination she
appears jaundiced and there is evidence of splenomegaly. Bloods reveal an elevated
unconjugated bilirubin and LDH. There is evidence of an elevated reticulocyte count. A blood
film reveals reticulocytes and spherocytes. Which of the following is the most useful in
differentiating hereditary spherocytosis from autoimmune haemolytic anaemia?
Haptoglobin
Osmotic fragility test
Direct Antiglobulin Test
Bone marrow biopsy