CICM SAQ 2015.1 Q18


18.1 The following data refer to a 65-year-old male admitted to ICU with septic shock on a background of active rheumatoid arthritis.

  • a) What abnormality is demonstrated in this patient? Give your reasoning. (20% marks)
  • b)  What is the pathogenesis of these changes? (20% marks)
  • c)  What specific treatment strategy would correct the demonstrated abnormality? (10% marks)

18.2 The following data refer to a 48-year-old female admitted electively to ICU following extensive pelvic surgery for invasive endometrial carcinoma. The patient has remained in ICU for 22 days because of complications including acute kidney injury.

  • a) What abnormality is demonstrated in this patient? Give your reasoning. (20% marks)
  • b) Give two potential causative factors in this patient. (10% marks)
  • c) Briefly outline the available treatment options to correct the demonstrated abnormality including any disadvantages / risks. (20% marks)


Answer and interpretation

18.1 a) Anaemia of Inflammation demonstrated by:

  • decreased haemoglobin
  • decreased iron
  • normal to high ferritin
  • suppressed erythropoietin
  • elevated CRP

b) Inflammation -> cytokines (IL6) -> increased hepcidin -> decreased iron release from bone marrow, decreased iron release from macrophages, decreased absorption of iron -> suppressed erythopoeisis

c) Control inflammation, no value to iron replacement, no value to the use of erythropoietin.

18.2 a) Iron deficiency anaemia as evidenced by:

  • decreased haemoglobin
  • decreased iron
  • decreased ferritin
  • increased erythropoietin
  • increased TIBC.

b) Blood loss; Pre-existing dietary deficiency


  • IV iron replacement – no demonstrated benefit and risks of adverse effects (awaiting Ironman study)
  • Oral iron replacement
  • Erythropoeitin – expensive and no demonstrated benefit
  • Blood transfusion – risks of transfusion including immunosuppression
  • Nil – may have reduced oxygen carrying capacity for some time until correction of Hb
Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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