1/4. mitral valve prolapse with pulmonary haemosiderosis and severe anaemia: cause or association?A 12 years boy presented with the history of pallor for one month. Two days before hospitalisation he developed fever, cough, shortness of breath. He had past history of such episode.On examination, his heart rate was found to be 120/minute, respiratory rate 40/minute and moderate anaemia was detected. Scattered creptus was audible over mid and lower lung fields and a soft systolic murmur was auscultated at apex. On investigations, Hb was found as 4.6 g/dl and HbF was less than 2%. plasma Hb was 5 g/dl. Straight x-ray chest showed bilateral patchy opacities over mid and lower zones. His sputum was found to be blood stained and prompted the possibility of blood loss occurring in the lungs, which was confirmed by demonstrating haemosiderin laden macrophages on three consecutive sputum specimens. echocardiography revealed a systolic displacement of mitral valve leaflets into the left atrium with co-optation superior to the plane of mitral annulus. Doppler study showed a minimal late systolic regurgitation. It was decided to treat the case as idiopathic pulmonary haemosiderosis. oxygen inhalation, hypertonic saline nebulisation, i.v. hydrocortisone, packed cell transfusion followed by oral prednisolone improved the patient's condition. After 3 months of discontinuing prednisolone, he remained asymptomatic. Here one case of pulmonary haemosiderosis characterised by abnormal accumulation of haemosiderin in the lungs following repeated alveolar haemorrhages with the presence of mitral valve prolapse is reported.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
2/4. iron deficiency anaemia: an unusual complication of Meckel's diverticulum.OBJECTIVES: To describe a case of Meckel's diverticulum with an unusual complication of iron deficiency anaemia due to chronic intestinal bleeding. CLINICAL PRESENTATION AND INTERVENTION: A 12-year-old boy presented with bloody diarrhoea and abdominal pain in association with a long-standing history of black stools and progressive pallor. Biochemical tests revealed low serum iron (1.2 mmol/l) indicating iron deficiency anaemia and low serum albumin (29 g/l). The other tests were normal. colonoscopy performed on the 8th day of hospitalization was normal. A technetium-99m pertechnetate scan showed an ectopic gastric mucosa in the Meckel's diverticulum confirmed at surgery in the region of the antimesentric border and on histopathology. CONCLUSION: Findings indicated that the patient had a bleeding Meckel's diverticulum, complicated by iron deficiency anaemia.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
3/4. Very severe iron-deficiency anemia in a patient with celiac disease and bulimia nervosa: a case report.A 29-year-old woman presented to the emergency department with exhaustion, fatigue, and abdominal pain. She reported having received a diagnosis of bulimia nervosa 10 years before. On examination, she had a marked pallor and was severely malnourished. Laboratory analysis revealed a dramatically low hemoglobin level of 1.7 g/dL (ref: 11.5-15.8 g/dL). Serum iron was quantified as 1.4 micromol/L (ref: 7-26 micromol/L), ferritin as 5 ng/mL (ref: 10-120 ng/mL), and the level of serum transferrin as 212 mg/dL (ref: 200-360 mg/dL). A duodenal biopsy revealed villous atrophy in the mucosal layer indicative for celiac disease. This diagnosis was confirmed by serum levels of endomysial antibodies, tissue transglutaminase antibody, and antigliadin antibodies. The newly diagnosed gluten-sensitive enteropathy is likely to be in part responsible for the severe symptoms reported. The extent of hemoglobin decline in combination with an astonishing lack of critical symptoms seen in this patient is a rarity. We conclude that anorectic patients with severe anemia and malnutrition should be evaluated for the presence of additional somatic conditions.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
4/4. Menetrier's disease presenting with iron deficiency anemia.Menetrier's disease (MD) or polyadenomes en nappe is a form of hypertrophic gastropathy occurring primarily in middle-aged males. patients generally present clinically with dyspepsia and, on occasion, with hypoproteinemic edema and anemia. The latter feature, when combined with the radiographic appearance of the stomach in MD, can lend to confusion with carcinoma and malignant lymphoma. To illustrate this diagnostic problem, a case is reported of a 41-year-old female who initially presented to her family physician with symptoms of easy fatigue and dyspnea on exertion and signs of pallor and ankle edema. Pertinent laboratory findings included a hemoglobin of 2.8 g/dL, hematocrit of 10.3 percent, mean corpuscular volume of 63.4 mu 3, a serum albumin of 2.7 g/dL, and heme positive stools. Endoscopic examination revealed a circumferential polypoid mass involving the cardia and fundus of the stomach with relative sparing of the antrum. A CT scan of the abdomen and pelvis showed a large mass in the stomach which the radiologists and gastroenterologists believed probably represented a lymphoma or gastric carcinoma. A total gastrectomy specimen exhibited features of MD. Routine bright-field microscopy and immunohistochemical reactivity for transforming growth factor-alpha confirmed the diagnosis of MD. Moreover, ulceration of the tips of some of the hypertrophied gastric folds provided an explantation for the iron deficiency anemia. awareness that MD may present with anemia will help in the differential diagnosis with lymphoma and carcinoma.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |