About a patient with anemia (Q: I-02)


 

 

A 45 year-old female patient,  who works as clerk in a school, goes to your office complaining of great  fatigue, weakness, lassitude and palpitations. It is accompanied with a desire to eat “strange stuff, like chalk, paper, hair…and a lot of ice” . She is afraid she is “becoming crazy”

 

During the interview the patient shows a normal behavior but with some anxiety. When questioned she informs about abundant menstruation since some months ago. At the physical sign you find intense pallor and a moderate tachycardia.

 

Significative laboratory results are the following:

 

–      Hemoglobin: 8.4

 

–      Peripheral smear: mycrocitic hypochromic red blood cells, no target cells detected.

 

–      Mean Corpuscular Volume (MCV) =65 fl (Reference range: 80-100 fl);

 

          Ferritin, serum: 7 ng/mL (Reference range:15-200 ng/mL).

 

          Total iron binding capacity (TIBC): Higher than normal

 

          Transferrine saturation: Decreased

 

          Free Erythrocyte protoporphyrin (FEP): Very increased

 

          Indirect bilirrubin: Normal

 

          Hemoglobin electrophoresis:  Normal pattern

 

          Bone marrow aspirate stained for Iron: No sideroblasts, no stainable iron

 

 

Based in the characteristics of the patient and the lab results, you can assume that the signs in this patient can be explained by an anemia resulting from:

 

 

a)     Anorexia nervosa

 

b)     deficit of Cobalamine

 

c)      deficit of Folic acid

 

d)     deficit of Iron

 

e)     deficit of Vitamin B6

 

f)       deficit of Folate and cyanocobalamine

 

g)     increased Hemolysis

 

h)    Pica

 

i)       Porphyria

 

j)       Lead poisoning

 

k)     Thalassemia Major

 

l)       Thalassemia minor

 

 

 

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