Patients with hypochromic microcytic anemia

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You work at the hematology department and during last three days was your office visited by three patients sent to you by three different doctors. All patients have the same laboratory result – hypochromic microcytic anemia. You take a history, perform a physical examination and subsequently take blood for some blood tests to confirm your diagnosis. You think, that each patient has different diagnosis. Do you reveal, what diagnosis have all patients and what tests should you do to confirm the diagnosis?

Questions:

What is it “anemia”? How can you do the diagnosis of anemia?

What does it mean “anemic syndrome”?

Convert the term “hypochromic microcytic anemia” to laboratory parameters describing red blood cells.

Patient nr. 1

First patient is 38-year-old accountant, mother of three children (2 girls and 1 boy), that is sent by her GP. Patient visited him, because she suffers from these symptoms for more than one year: fatigue, muscle weakness, and frequent occurrence of cold and tonsillitis. She thought, that all these problems were caused by the birth of her last baby (one and half year ago) and that they should diminish in time. Unfortunately are the symptoms still worse and worse. Patient has no other serious illness and has no abnormal findings on physical examination (only slightly higher heart rate). After consideration of all facts in history you think, that you know the cause of her hypochromic microcytic anemia.

Questions:

How can you explain patient´s symptoms: fatigue, muscle weakness and more frequent cold ? What is their cause?

What is cause of patient´s anemia?

What tests should you do to confirm the diagnosis? What results do you expect?

Is there any connection between symptoms and pregnancy/birth? Explain.

Patient nr. 2

Second patient is 38-year-old university teacher, childless, that has Crohn’s disease more than 20 years. This disease is localized in ileocaecal region (revealed by endoscopy) and is stabilized nowadays (during 20 years there were several episodes of stabilization and subsequent worsening). Her GP was very surprised by the finding of hypochromic microcytic anemia, because our patient takes iron and vitamin B12 substitution since 27 years (both recommended by gastroenterologist). After consideration of all facts in history you think that you know the cause of her hypochromic microcytic anemia.

Questions:

Why has our patient iron and vitamin B12 substitution since 27 years?

Why was her GP surprised by by the finding of a hypochromic microcytic anemia? Could it be modified by iron and vitamin B12 substitution?

What ferritin level do you expect? Explain.

Is there any connection between Crohn’s disease and patient´s anemia? Explain.

 

Patient nr. 3

Third patient is 38-year-old manager from Greece that is now pregnant – her first baby (now in 12th week). Patient suffers from hypochromic microcytic anemia for longer time (she doesn’t remember exactly, when it was discovered for the first time). She had never problems with this anemia, but when she started to plan to have a baby three years ago, prescribed her her family doctor iron substitution. Our patient doesn’t know, whether her family doctor controlled the therapy results in time. During her first prenatal visit took her obstetrician blood and the results showed a hypochromic microcytic anemia again. Ultrasound confirmed an intrauterine pregnancy at 12-weeks gestation with no pathology findings.

Patient has no other serious illness and has no abnormal findings on physical examination (her physical exam is consistent with a 12-week pregnancy). In her family history you found these interesting findings: both her brothers have anemia also (one of them requires frequent transfusions). After consideration of all facts in history you think, that you know the cause of her hypochromic microcytic anemia.

Questions:

Do you expect, that both her brothers have hypochromic microcytic anemia also? Explain.

What is cause of patient´s anemia?

What tests should you do to confirm the diagnosis? What results do you expect? Do you want fetus examination also?

Was the iron substitution (prescribed by her family doctor) a correct therapy?