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Anaemia Workup Controlled RA — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisAnaemia Workup Controlled RASCE Rheumatology

A 58-year-old postmenopausal woman with rheumatoid arthritis has persistent anaemia on two consecutive blood tests. Her haemoglobin is 102 g/L and MCV 90 fL; her white-cell and platelet counts are normal. Her rheumatoid arthritis is clinically well controlled and CRP is 5 mg/L. What is the most appropriate next step?

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Correct answer: B — Request blood film, reticulocytes, haematinics, and renal and liver function tests

The correct answer is B. Persistent normocytic anaemia requires a structured evaluation even in a patient with rheumatoid arthritis. Normal MCV does not exclude iron deficiency or mixed haematinic deficiencies. Initial tests should include a blood film, reticulocyte count, ferritin/iron studies, vitamin B12 and folate, renal and liver function, with clinical assessment for blood loss. Well-controlled RA and a low CRP make active inflammation a less convincing sole explanation. If iron deficiency is confirmed, its cause should be investigated, including gastrointestinal blood loss in a postmenopausal woman and medication-related bleeding where relevant. Bone marrow biopsy is not first-line when the other cell lines are normal and should be reserved for unexplained anaemia or concerning film findings. Inflammatory markers alone or delayed FBC repetition would leave important treatable causes unexamined.

Reference: Harrogate and District NHS Foundation Trust. Haematology GP Pathway Guide, section: Normocytic anaemia. 2025. https://www.hdft.nhs.uk/wp-content/uploads/2025/04/Haematoplogy-GP-Pathway-Guide.pdf