1. Anemia case # 1
prepared by Reham Abu Elamrain Aseel Elnemnem Ashwaq Barbakh Noor Abu Mostafa

2. Case Report

3. A twenty year-old, moderately built male was visited out-patient medicine ward at a tertiary care hospital with the chief complaints of generalized weakness and dyspnea on gesture.
He reported a history of epistaxis, occasional black stools and also had the history of jaundice six years back, and had taken herbal medicines for the treatment.
Fifteen days earlier to his visit to tertiary care hospital, the patient visited the primary care hospital with similar complaints and was primarily diagnosed the condition as anemia, no treatment was started immediately and the physician advised the patient to undergo clinical laboratory tests including haemogram, erythrocyte sedimentation range (ESR), liver function test, stools for occult blood, vitamin B12, serum ferritin, serum creatinine and the results were given in table 1. After evaluating the reports, physician prescribed iron supplement along with other vitamins and recommended to ENT specialist to evaluate the condition epistaxis.

4. ENT specialist suspected the case as iron storage disorder after following the previous lab reports and recommended the patient to consult department of hematology for further evaluation.
On reporting in the tertiary care hospital, with the persistent symptoms, the patient had undergone various clinical laboratory investigations on recommendation of the physician and the results of the various lab tests were shown in the table 1.
The physician provisionally diagnosed the condition as chronic blood loss anemia and iron deficiency anemia with suspecting hereditary hemorrhagic telangiecturia (HHT).

6. Discussion

7. This is a rare unknown case of severe IDA observed in a young moderately built male, which we generally observe in pregnant women because of ability of fetus to extract its iron requirements from mother and iron deficiency is the commonest condition occurs in 80% of pregnant women .
Here, in this case the patient observed the symptoms of generalized weakness and dyspnea is due to reduced oxygen carrying capacity by the deficiency of hemoglobin (anemia).
The reports of hemoglobin concentration, packed cell volume, mean corpuscular volume and mean corpuscular hemoglobin reveals the evidence for blood disorder anemia where as the added evidences like depleted levels of serum iron, serum ferritin and total binding capacity and laboratory investigations.
The reasons for iron deficiency were still unclear, further evaluations are
.necessary to rule out the actual etiology

8. Bone marrow biopsy and a complete family history are recommended for conclusive answers to understand the specific causes for IDA.
Patients with IDA generally have the elevated platelet count and the present case also shown the condition of thrombocytosis .
HHT is an autosomal dominant disorder characterized by arteriovenous malformations of skin mucosa and viscera. Based on the patient’s symptoms like epistaxis and black stools, the physician also suspected the condition as HHT, but the results of CT scan of paranasal sinuses and stools occult blood analysis respectively doesn’t provided any evidence for HHT .

9. Conclusion

10. In this case, the physicians were clinically diagnosed the condition as IDA based on the presence of microcytic and hypochromic Red Blood Cells in peripheral blood smear test confirms the anemia as IDA.

11. Iron deficiency anemia (IDA)

12. Iron deficiency anemia is the most common type of anemia, and it occurs when your body doesn’t have enough of the mineral iron. Your body needs iron to make hemoglobin. When there isn’t enough iron in your blood stream, the rest of your body can’t get the amount of oxygen it needs.
While the condition may be common, many people don’t know they have iron deficiency anemia. It’s possible to experience the symptoms for years without ever knowing the cause.
In women of childbearing age, the most common cause of iron deficiency anemia is a loss of iron in the blood due to heavy menstruation or pregnancy. A poor diet or certain intestinal diseases that affect how the body absorbs iron can also cause iron deficiency anemia.
Doctors normally treat the condition with iron supplements or changes to diet.

13. The symptoms of moderate to severe iron deficiency anemia include:
1- general fatigue
2- weakness
3- pale skin
4- shortness of breath
5- dizziness
6- strange cravings to eat items that aren’t food, such as dirt, ice, or clay
7- a tingling or crawling feeling in the legs
8- tongue swelling or soreness
9- cold hands and feet
10- fast or irregular heartbeat
11- brittle nails
12- headaches

14. Causes of iron deficiency anemia
1- Inadequate iron intake
2- Pregnancy or blood loss due to menstruation
3- Internal bleeding
4- Inability to absorb iron
5- Endometriosis

15. Risk factors 1- women of childbearing age 2- pregnant women
3- people with poor diets
4- people who donate blood frequently
5- infants and children, especially those born prematurely or
experiencing a growth spurt
6- vegetarians who don’t replace meat with another iron-rich food

16. How it’s diagnosed

17. A doctor can diagnose anemia with blood tests. These include:
1- Complete blood cell (CBC) test
including:
- red blood cells (RBCs)
- white blood cells (WBCs)
- hemoglobin
- hematocrit
- platelets
The CBC provides information about your blood that is helpful in diagnosing iron deficiency anemia. This information includes:
- the hematocrit level.
- the hemoglobin level
- the size of your RBCs

18. Other tests
Anemia can usually be confirmed with a CBC test. Your doctor might order additional blood tests to determine how severe your anemia is and help determine treatments. They may also examine your blood through a microscope.
These blood tests will provide information, including:
1- the iron level in your blood
2- your RBC size and color (RBCs are pale if they’re deficient in iron)
3- your ferritin levels
4- your total iron-binding capacity (TIBC)

19. Tests for internal bleeding
If your doctor is concerned that internal bleeding is causing your anemia, additional tests may be needed. One test you may have is fecal occult test to look for blood in your feces. Blood in your feces may indicate bleeding in your intestine.
Your doctor may also perform an endoscopy, in which they use a small camera on a flexible tube to view the linings of your gastrointestinal tract. An EGD test, or upper endoscopy, allows a doctor to examine the lining of the esophagus, stomach, and the upper part of the small intestine. A colonoscopy, or lower endoscopy, allows a doctor to examine the lining of the colon, which is the lower portion of the large intestine.
These tests can help identify sources of gastrointestinal bleeding.