Disproportionate elevation of jugular venous pressure in pleural effusion

Constrictive pericarditis is characterized by elevation in jugular venous pressure disproportionate to the severity of concurrent breathlessness. As pleural effusion may be an associated feature it is recommended that jugular venous pressure should be documented in all patients who present with pleural effusion.

Does this elderly patient have iron deficiency anaemia, and what is the underlying cause?

Important implications for the recognition of iron deficiency anaemia include diagnosis and correction of underlying causes, most of which are identifiable, in the older patient, by means of conventional upper gastrointestinal endoscopy, and by colonoscopy. The aetiological search may, however, have to be widened to include enteroscopic examination of the jejunum and ileum and, in some instances, investigation of potential non-gastrointestinal foci of chronic blood loss. A substantial minority may defy even the most thorough search for the underlying cause.

Prevalence of hypochromia (without microcytosis) vs microcytosis (without hypochromia) in iron deficiency

The usefulness of hypochromia (MCH <or = 26 pg) and microcytosis (MCV < or = 80 fl) as indicators of iron deficiency was examined in 365 geriatric patients aged 67-96 years with either one or both or these characteristics. Of these, 201 proved to be iron deficient with a serum ferritin of 18 microg/l. There was a highly significant difference (P < 0.001) between the proportion of iron deficient patients with a mean corpuscular haemoglobin (MCH) < 26 pg (in the presence of a mean corpuscular volume (MCV) > or = 80 (fl) vs. counterparts with MCV < 80 fl (in the presence of MCH > or = 26 pg). Fifteen per cent of the 201 iron deficient subjects were also shown to have coexisting vitamin B12 deficiency. There was a comparable (16%) prevalence of this haematinic deficiency in the subgroup of 31 iron deficient patients with MCH < 26 pg in the presence of MCH > or = 80 fl.