Iron-deficiency anemia; response to therapy (double red cell population – hypochromic and normal)
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2016, Vol 33, Issue 1
Abstract
A 41-year-old man was admitted to our Department because of severe anemia. He had complained about weakness, fatigue, headache, and dyspeptic symptoms for the four months. His past medical and family history was unremarkable. On admission, the physical examination revealed pallor, a sensitivity in the upper abdomen while patient’s temperature, blood pressure and pulse rate were within normal limits. The nails were fragile tending to thinning and flattening. There was a mild atrophy of the lingual papillae and an angular stomatitis. The spleen was slightly enlarged (only the tip was felt); no hepatomegaly or lymphadenopathy was observed. The neurological examination revealed no abnormalities. His hematological profile was as follows: WBC 6.8×109/L (differential count: neutrophils 56%, lymphocytes 35%, monocytes 6% and eosinophils 4%), Hb 7.0 g/dL, Ht 22.2%, MCV 70.3 fL, MCH 23.0 pg, MCHC 29.6 g/dL, RDW 17.6% and platelet count 304×109/L. The reticulocyte count was 4.6% and the ESR was 50 mm/1h. The examination of the peripheral blood smears revealed hypochromia, microcytosis, anisopoikilocytosis and mild elleiptocytosis (fig. 1). The morphology of granulocytes and platelets was normal. Serum biochemistry was within normal limits except of the following: iron concentration 45 μg/dL, ferritin levels 20 ng/mL and TIBC 316 μg/dL. Bone marrow aspiration is shown in figure 2. The thyroid function tests, the X-rays of the chest and the electrocardiographic evaluation were revealed no abnormalities. The ultrasonography of the abdomen was normal while the endoscopy of the upper gastrointestinal system revealed a moderate esophageal hiatal hernia with the presence of ulceration to the gastric mucosa at the neck of the hernial sac. The diagnosis was established and the administration of the Figure 1A revealed no abnormalities. The ultrasonography of the abdomenappropriate medication was started. One month after treatment initiation the hemoglobin level was 10.6 g/dL and the hematocrit 32%. The reticulocyte count was 7.8% and the peripheral blood smears image is shown in figure 3. Three months of treatment resulted in the correction of blood parameters, the normalization of the tongue and nails appearance and the absolute relief of the dyspeptic symptoms.
Authors and Affiliations
J. ASIMAKOPOULOS, L. PAPAGEORGIOU, V. TELONIS, A. ZANNOU, P. ARAPAKI, T. GIANNIKOS, E. NIKOLAOU, G. DRYLLIS, I. KONSTANTINOU, M. ANGELOPOULOU, K. KONSTANTOPOULOS
Keywords
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