Question of the Week

Question

Question :

Posted On : 07 Apr 2015

16 yr old girl child, frm well to do family comin from coorg presented with on and off weakness for last 6 months w, taken opd RX and also one blood transfusion. on examination presently severe pallor, stable not tachypneic or dyspneic,no jaundice, no LN or HSG. comfortable. also not attained menarche yet . initially thought of sickle or thalassemia as pt is frm coorg. on Investigation, hb is 3, P smear shows microcytic hypochromic anemia with pencil shaped cells, anisopoikilocytosis. retic ct 3 percent.MCV, MCHC, MCH all low. RDW is high. sickling test negative, coombs test negative, hB electrophoresis normal, serum ferritin normal , TIBC - normal.bone marrow aspiration normal { biopsy report awaited}.TSH is on higher side ,done incidentally bcox of late menarche.started the child on thyroxine. read in sum books tat in adults iron deficiency anemia may be the first presentation of hypothyroidism. childs TPO antibody came positive. ANA negative, stool normal. so dilemna is even thou i have put the child on thyroxine, bt cause of anemia is nt sure. bcox in literature its written even thou hypothyroidism can cause anemia , bt not so low to cause hb of 3. . wat cld be teh reason here. pl reply

Expert Answer :

Answer Discussion :

No answer discussion available.

Answer 1

As this child has severe anemia without decompensation, it means that it is chronic anemia. 6 months ago this child has received blood transfusion and so it has recurred again in 6 months time. General weakness over last 6 months suggets gradually worsening anemia especially if you get history of fatigue slowly worsening. Anemia without HSmegaly is either deficiency or aplasis, hypoplasia of bone marrow. It is unlikely that iron deficiency anemia would recur unless there is severe bleeding over time such as menorrhagia. B12 deficiency often recurs if treated with only blood transfusiion and not by B12 replacement. However this is microcytic hypochromic anemia with low MCV - that is against B12 deciciency. Aplastic anemia would have pancytopenia - those details are not provided and one may not get microcytic hypochromic picture in aplasia , hypoplasia. So given details are not conclusive. You may have to repeat tests under supervision of hematologist. Hypothyroidism is unlikely to explain severe anemia but it may be just another compounding feature of chronic inflammatory disease that may be having microscopic GI bleeding. I hope bone marrow biopsy may reveal diagnosis.

Question of the Week

Home

Partner Sites