A subtle case of iron-deficiency anemia

Excerpt

An otherwise healthy, 28-year-old woman was referred to our institution because of iron-deficiency anemia. Her medical history was remarkable only for childhood-onset migraine and β-thalassemia trait. She reported having been slightly anemic ever since this was discovered, with hemoglobin ranging between 9.0 and 11.0 g/dl. Her menses were reportedly regular. Fourteen months prior to admission, the hemoglobin was 8.3 g/dl, while the serum iron was 93 μg/dl (n.v., 35–156); ferritin was normal. Five months later, the hemoglobin was 8.8 g/dl, but serum iron and ferritin were 26 μg/dl and 12 ng/ml, respectively. She was prescribed a daily oral iron supplement, with no improvement after 1 month. Therefore, the patient was shifted to intravenous iron administration, and 2 months later the serum iron was 36 μg/dl. Two months prior to admission, the hemoglobin and serum iron were 7.7 g/dl and 23 μg/dl, respectively. Two days before referral to our institution, the hemoglobin and serum iron were 6.0 g/dl and 15 μg/dl, respectively; ferritin was 10 ng/ml. On admission, the physical examination disclosed no abnormalities, apart from signs of anemia. The patient had no fever, weight loss, or night sweats. Laboratory tests, including liver and kidney functions, electrolytes, glucose, cholesterol, LDH, creatine kinase, uric acid, β₂-microglobulin, ESR, were normal; CRP was negative. Serum protein electrophoresis was normal. Antibodies against α-gliadin and tissue transglutaminase were not detected [1]. Esophagogastroscopy, colonoscopy, and abdominal ultrasound studies were normal. Eventually, a discrete area of endometrial thickening on transvaginal ultrasonography was identified as the likely source of chronic bleeding by a gynecologic consultant. Thus, following uterine curettage (histology negative for malignancy), the patient was given iron intravenously to replenish deposits, and was eventually discharged. …