Case study (51) – Iron deficiency anemia

 Case study (51) – Iron deficiency anemia

Questions:

Q1. What abnormalities are shown in this blood film? What is the likely diagnosis?

Q2. What abnormality is shown? What is the likely diagnosis?

Q3. What abnormality is shown? What is the likely diagnosis?

Q4. What abnormality is shown? What are the possible causes?

Answers:

A1. A28.This blood film shows hypochromic, microcytic red blood cells with occasional target cells. The features suggest iron deficiency.

A2. This patient has multiple telangiectasias over the tongue and lips and suffers from hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome). Chronic iron deficiency may result from gastrointestinal blood loss. The condition is inherited as an autosomal dominant.

A3. The appearance of the nails are those of koilonychia (spoon-shaped nails), which is seen in chronic iron deficiency. Other skins and mucosal changes in iron deficiency include:

⚫ Brittle nails

⚫ Angular cheilitis

⚫ Postcricoid and pharyngeal webs (Plummer–Vinson syndrome), which may present as dysphagia

A4. Clubbing. This is associated with pulmonary arteriovenous fistulae in hereditary hemorrhagic telangiectasia, as shown in the chest x-ray.

Other causes of clubbing include:

⚫ Carcinoma of the bronchus

⚫ Suppurative lung disease

⚫ Cyanotic congenital heart disease

⚫ Cirrhosis

⚫ Inflammatory bowel disease