Dept of Medicine

1
Dept of Medicine Pathology CWM Hospital Fiji
School of MedicineWeekly CPC Meeting
Mar 4 2004 32y Fiji Indian Female Severe anemia.
2
Clinical details

• 32 Year Fiji Indian Female
• Weakness, tired, pale few weeks.
• Dysphagia, not on any medication
• Food Craving (pica),
• Likes eating Ice..!
• No significant past history
• No Menorrhagia, no hematuria

3
Laboratory Data

• Hb 2.6gm/dl (confirmed!)
• MCV 53
• WBC normal in number
• PLT 380,000
• Eosinophils 8
• Ferritin 3.4
• Serum iron very low.

4
Blood smear Findings

• Microcytes (compare with lymphocyte)
• Hypochromic
• Anisopoikilocytosis
• Platelet
• Eosinophil

5
Blood smear Findings

• Microcytes (compare with lymphocyte)
• Hypochromic
• Anisopoikilocytosis.
• Platelet
• Pencil forms of RBC (elongated)

6
Blood smear Findings

• Microcytes (compare with lymphocyte)
• Hypochromic
• Anisopoikilocytosis.
• Platelet
• Pencil forms of RBC (elongated)

7
Blood smear Findings

• Microcytes (compare with lymphocyte)
• Hypochromic
• Anisopoikilocytosis.
• Eosinophil
• Pencil forms of RBC (elongated)

8
Iron Deficiency Anemia

• Marked Microcytic hypochromic anemia.
• Pencil forms of RBC (suggest iron def)
• Eosinophilia (? Hook worm inf)
• Also this patient had dysphagia typical in iron
  deficiency due to lower oesophageal sphicter
  formation. (Plummer Vinson syndrome)

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Iron Deficiency Anemia

• Note that Iron deficiency is not final diagnosis.
• Transfused with two units of packed RBC.
• This patient is posted for endoscopy to rule out
  bleeding peptic ulcer.
• Stool examination requested for parasites
  occult blood.
• Mebendazole started.