anaemia

Delayed splenic rupture is a rare but well recognised clinical phenomenon with significant morbidity and mortality. We describe an 84-year-old woman with persistent unexplained anaemia requiring transfusion following a fractured neck of femur. One month after hemiarthroplasty, she collapsed and became haemodynamically unstable with profound anaemia. Computed tomography of the abdomen revealed splenic haematoma with haemoperitoneum, with splenic rupture confirmed at the post-mortem examination.

The full blood count (FBC) is perhaps the single most common investigation performed in medical patients. It has the potential, when interpreted carefully and in relation to the clinical history, to provide very useful information to assist in diagnosis and management. Clinicians are often alerted to the presence of a primary haematological disorder by abnormalities in the FBC. For the purpose of this review these diseases will not be discussed in detail but the reader will be alerted to pointers which might indicate primary blood disorders throughout the text.

Anaemia is common in a wide range of malignancies and individual studies have demonstrated it to be an independent prognostic marker for survival in certain cancer types. The study population consisted of 171 patients: 77 anaemic and 94 non-anaemic. Sixty per cent of the study population had adenocarcinoma with 37% having squamous cell carcinoma. Late-stage disease occurred in 80% of individuals. There was no significant difference in survival times between the two groups (p=0.1), and after adjusting for confounding factors including age, sex, stage and physical status (p=0.8).