Anaemias & Haematinics
Iron, B12, folate and erythropoiesis — filling an empty tank.
The Approach to Anaemia: Reading the MCV to Find the Cause
Anaemia is not a diagnosis — it is a clue. A patient is pale and exhausted, the haemoglobin is low, and the temptation is to reach for iron. But which anaemia? The whole differential — a long, frightening list — collapses into three tidy boxes the moment you read one number on the full blood count: the MCV. Learn to read it and the second axis, the reticulocyte count, and the blood film stops being a mystery and becomes a map that points straight at the treatment.
Iron Deficiency and Iron Therapy: Oral, IV, and Why Timing Matters
She is 24, exhausted, breathless on the stairs, and her tablets have turned her stool black. She takes them faithfully — with her morning coffee — and after two months her blood count has barely moved. Nothing is wrong with the iron. Everything is wrong with the timing. Follow one iron atom from the plate to the marrow and you will see exactly where half her dose is lost, why alternate-day dosing can beat daily, and when a tablet is simply the wrong tool.
Vitamin B12 and Folate: Megaloblastic Anaemia and the Trap of Treating Blindly
Two vitamins, one job: building the DNA that lets a cell divide. Starve a marrow of either and it produces huge, clumsy, immature red cells — megaloblastic anaemia. But the two are not interchangeable, and one deadly shortcut can hide behind the other. Give folate alone to a patient who is actually short of B12 and you will polish the blood count while the spinal cord quietly rots. This is the story of how to tell them apart — and why you never treat blind.
Erythropoiesis-Stimulating Agents: Anaemia of Kidney Disease and Chronic Illness
The kidney is not only a filter — it is a sensor. When it feels the blood running thin on oxygen, it releases a hormone that orders the marrow to build more red cells. Let the kidney fail, and that order never gets sent: the marrow goes quiet and the patient fades into exhaustion. This is the story of erythropoietin, the drugs that replace it, and the sharp lesson that with these agents more is not better — pushing the blood count too high can kill.
