Chronic Anemia - Anemia FAQs

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
An 18 year old boy born from non consanguineous marraige, presented as chronic anemia was under evaluation since 2000. He showed fatigability, paleness of body, intermittent abdominal pain, swelling over body [diagnosed as iron deficiency anemia]. He was positive for occult blood in stool repeatedly,. He was further investigated by colonoscopy, USG and RBC labelled GI bleed scan which were normal. A urine routine examination was normal. Hb electrophoresis was normal. A CT enteroclysis reveled jejunal wall thickening and jejunal polyp. But there was no H/O frank blood in stools, no H/O recurrent enteritis., O/E marked pallor, mallor, erythemaus rashes on the face, mild hepato splenomegaly, no rash on the body, no LNpathy, no arthritis. A younger sister of patient is also having anemia and abdominal pain intermittently but not investigated. So what could be the final diagnosis?
Answer
What type of anemia is it? If it is normocytic normochromic, rule out chronic renal failure, liver disease, HIV and other chronic diseases. If it is microcytic hypochromic anemia and stool for occult blood is positive, it may suggest iron deficiency anemia. Stool for occult blood may be positive if the child is on hematinics. If the stool examination was done when the child was not on hematinics, it suggests a bleed above the 3rd part of duodenum. In this case colonoscopy may not help and upper GI scopy may be required to rule out gastritis and H.pylori infection. If the stool for occult blood was positive while the child was on hematinics, then one may do serum iron studies and reticulocyte count, If retic count is low, bone marrow examination may be required. Back to All Questions

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