CPD

• Microcytosis is commonly due to thalassaemia and iron deficiency.
• The diagnosis of thalassaemia in asymptomatic individuals is generally of no consequence to the patient but may have significant reproductive implications in individuals of child-bearing age if their partner also carries a globin-gene mutation.
• Investigate macrocytosis in individuals where a cause is not evident on clinical assessment; consider haematological malignancies and cobalamin (B12) or folate deficiency in patients not taking drugs which can cause macrocytosis.
• Testing for homocysteine or methylmalonic acid is more sensitive for cobalamin deficiency than measuring serum B12 levels.

Keeping LDL-C levels lower throughout life can help substantially reduce CVD risk.¹ GPs play an essential role in identifying patients at risk of CVD and managing their treatment.² This includes prescribing lipid-lowering medicines for people at high risk of CVD.³ Although for most patients, elevated lipids can be assessed and managed effectively by GPs, there are some groups of patients who may benefit from referral to a specialist.⁴ These include patients whose total cholesterol is more than 7.5mmol/L, patients who fail to show an effective response to second-line treatment and those with familial hypercholesterolaemia.⁴