Case Study: Iron Deficiency Anemia
Patient Information:
- Name: John Doe
- Age: 35
- Gender: Male
- Occupation: Construction Worker
- Medical History: No significant medical history reported.
Presenting Complaint: John Doe presents to the clinic with complaints of fatigue, weakness,
and shortness of breath on exertion for the past few months. He reports feeling unusually tired,
even after a full night's sleep, and has noticed increased paleness of his skin and conjunctiva.
Physical Examination Findings:
- Vital Signs: BP 120/80 mmHg, HR 80 bpm, RR 16 breaths/min, Temp 98.6°F
- General: Pale skin and conjunctiva, fatigue apparent
- Cardiovascular: Regular rhythm, no murmurs or abnormal sounds
- Respiratory: Clear lung fields bilaterally
- Abdomen: Soft, non-tender, no organomegaly
- Neurological: Intact cranial nerves, normal motor and sensory functions
Laboratory Investigations:
- Hemoglobin (Hb): 9.5 g/dL (Normal range: 13.5-17.5 g/dL)
- Hematocrit (Hct): 29% (Normal range: 40-50%)
- Mean Corpuscular Volume (MCV): 75 fL (Normal range: 80-100 fL)
- Serum Iron: 25 mcg/dL (Normal range: 60-170 mcg/dL)
- Total Iron Binding Capacity (TIBC): 400 mcg/dL (Normal range: 250-450 mcg/dL)
- Ferritin: 10 ng/mL (Normal range: 30-400 ng/mL)
Diagnosis: John Doe is diagnosed with iron deficiency anemia based on his clinical presentation,
physical examination findings, and laboratory results.
Questions for Students:
- What are the common signs and symptoms of iron deficiency anemia?
- Explain the laboratory findings in John Doe's case and how they support the diagnosis of
iron deficiency anemia.
- What are the potential causes of iron deficiency anemia in adults, and how would you
approach further investigations in this patient?
- Discuss the treatment options for iron deficiency anemia, including dietary
recommendations and pharmacological interventions.
Full Answer Section
- Shortness of Breath (Dyspnea) on Exertion: As oxygen-carrying capacity diminishes, the body struggles to meet oxygen demands during physical activity, leading to breathlessness. John Doe's complaint of shortness of breath on exertion is a classic symptom.
- Dizziness or Lightheadedness: Due to reduced oxygen supply to the brain.
- Headaches: Often described as frequent or persistent.
- Tachycardia or Palpitations: The heart works harder and faster to compensate for the reduced oxygen supply.
- Cold Hands and Feet: Poor circulation due to insufficient red blood cells.
- Brittle Nails (Koilonychia): Spoon-shaped or concave nails, though less common.
- Hair Loss: Thinning or brittle hair.
- Pica: Cravings for non-nutritive substances like ice, dirt, or clay.
- Restless Legs Syndrome (RLS): An irresistible urge to move the legs, often accompanied by uncomfortable sensations.
- Glossitis: Inflammation and soreness of the tongue.
- Dysphagia (Difficulty Swallowing): Due to esophageal webbing (Plummer-Vinson syndrome), a rare but severe complication.
- Irritability or Difficulty Concentrating: Cognitive impacts due to reduced oxygen to the brain.
2. Explain the laboratory findings in John Doe's case and how they support the diagnosis of iron deficiency anemia.
John Doe's laboratory findings provide strong evidence for the diagnosis of iron deficiency anemia, fitting the classic pattern:
- Hemoglobin (Hb): 9.5 g/dL (Normal range: 13.5-17.5 g/dL)
- Explanation: John's Hb is significantly below the normal range, indicating anemia. Hemoglobin is the protein in red blood cells that carries oxygen, and its low level directly explains his fatigue and shortness of breath.
- Support for IDA: IDA is the most common cause of microcytic hypochromic anemia, characterized by low hemoglobin.
- Hematocrit (Hct): 29% (Normal range: 40-50%)
- Explanation: Hct represents the percentage of red blood cells in the blood volume. John's Hct is low, consistent with anemia and a reduced red blood cell mass.
- Support for IDA: A low Hct is a general indicator of anemia, aligning with the low Hb.
- Mean Corpuscular Volume (MCV): 75 fL (Normal range: 80-100 fL)
- Explanation: MCV measures the average size of red blood cells. John's MCV is below the normal range, indicating microcytic (small cell) anemia.
- Support for IDA: This is a hallmark of IDA. When there isn't enough iron, the body cannot produce adequate hemoglobin for each red blood cell, causing the cells to be smaller than normal.
- Serum Iron: 25 mcg/dL (Normal range: 60-170 mcg/dL)
- Explanation: Serum iron measures the amount of iron circulating in the blood. John's level is significantly low.
- Support for IDA: This directly shows a lack of available iron for hemoglobin synthesis.
- Total Iron Binding Capacity (TIBC): 400 mcg/dL (Normal range: 250-450 mcg/dL)
- Explanation: TIBC measures the blood's capacity to bind iron. While John's level is at the higher end of the normal range, in the context of very low serum iron, a high or even high-normal TIBC indicates that the body is trying to absorb more iron because it is deficient. It has many "empty seats" (transferrin) waiting for iron to bind.
- Support for IDA: A high TIBC in conjunction with low serum iron is a classic pattern in IDA, reflecting the body's compensatory response to iron deficiency.
- Ferritin: 10 ng/mL (Normal range: 30-400 ng/mL)
- Explanation: Ferritin is a protein that stores iron in the body. John's ferritin level is very low.
- Support for IDA: This is the most sensitive and specific test for diagnosing iron deficiency, as it directly reflects the body's iron stores. A low ferritin level unequivocally indicates depleted iron stores.
In summary, John's labs show a
microcytic anemia (low MCV), with evidence of severely depleted iron stores (low ferritin), low circulating iron (low serum iron), and the body's attempt to compensate by increasing its iron-binding capacity (high TIBC relative to serum iron), all of which are classic indicators of iron deficiency anemia.