A 25-year-old young man came with a history of tiredness, mouth ulcers and numbness and tingling sensation over his hand and feet. Haematological investigation revealed RBC count is 3.2 million/cuu mm. Haemoglobin - 9.1 gm%, MCV was 121.6 fL. MCHC was 34 g/dL. MCH - 30 pg. Peripheral smear showed the presence of hyper-segmented neutrophils and megakaryocytes.

a. What is the most probable diagnosis?
b. What is the physiological basis for megakaryocytes?
c. What is the treatment given?

a. Megaloblastic anemia (from the symptoms & investigation)

b. Vitamin B12 is required for DNA synthesis, and maturation of RBC, from the proerythroblast stage to mature RBC. In the deficiency of B12, large RBCs (megaloblasts) are seen.

c. Vit B12 - Intramuscular route. Also supplement with the animal source of B12 - meat, liver, fish.

A 35-year-old female had come to a medical outpatient department with complaints of weakness, giddiness and loss of appetite. On examination she was pale. On investigation RBC count: 3.5 million/mm³, Hb: 9 g%. Peripheral smear showed microcytes with hypochromia.

a. Identify the condition.
Ans: Iron deficiency anaemia (microcytic hypochromic anaemia)

b. Discuss the physiological basis for the above condition and its management.

c. Discuss the stages of erythropoiesis.

d. Describe the various factors which regulate erythropoiesis.

A 30-year-old lady comes to hospital with complaints of fatigue for many months. On physical examination she had pale conjunctiva and spooning of nails. Her haemoglobin is 8 g%, PCV 20% and MCV 60 fL. Stools are negative for occult blood.

a. Name the clinical condition.
Ans: Iron deficiency anaemia (microcytic hypochromic anaemia)

b. Describe the blood picture.

c. What other investigations would you like to do in this setting?

d. What are the dietary options for better treatment?