Fever, Microcytic hypochromic anaemia, failure to thrive, sp | Figure 1

Case Presentation

Fever, Microcytic Hypochromic Anaemia, Failure to Thrive, Splenomegaly

Female patient, 14 yrs old, presented at the age of 6 months with:

• High grade fever
• Resistant microcytic hypochromic anemia
• Failure to thrive
• Huge splenomegaly

Timing of Interventions:
At the age of 5 years, splenectomy was done. Other symptoms remain present.

Examination Findings

• Pallor
• Weight and height below 3rd percentile
• Absence of secondary sexual characteristics

Investigation Results

• Microcytic Hypochromic Anaemia
• Iron Study: Normal ferritin with low iron level
• Investigation of Hemolysis: Negative
• Enzyme Assay of Gaucher and Niemann-Pick: Normal
• Infectious Screen (Toxoplasma, CMV, Rubella, HIV, Hepatitis B, C): Negative
• Kidney and Liver Function: Normal
• Bone Marrow Examination: Normal
• Immunoglobulin Levels: Elevated
• Leishmania Antibody: Negative
• Thyroid Hormones and Growth Hormone: Normal

Additional Cases

Case 1

Description: Female child, 4.5 years old,:

• Normocytic hypochromic anemia of 6 g/dL for 3 years with no other symptoms.
• TLC and platelets normal, bilirubin, G6PD, iron, ferritin, electrophoresis, osmotic fragility, autoimmune markers, and creatinine are normal.

Case 2

Description: A middle-aged patient with:

• Gradually developing fatigue
• Reduced endurance
• Occasional dizziness
• Mild pallor
• No overt bleeding, significant weight loss, or night sweats

Lab Results:

• Mild microcytic, hypochromic anemia with hemoglobin slightly below normal limit
• Increased serum iron and transferrin saturation with normal to reduced total iron-binding capacity
• Bone marrow examination revealed erythroid hyperplasia and ring sideroblasts.

Diagnosis: Sideroblastic anemia. Treatment included possible reversible causes investigation and high-dose pyridoxine supplementation.

Case 3

Discussion: 5-month-old female infant - 6.6 kg:

• Normal vaginal delivery
• Breast-fed
• No organomegaly, jaundice, or dysmorphic features
• Investigations before blood transfusions show microcytic hypochromic anemia (HB 3.2).

Case 4

Description: 59 years old patient:

• Presenting with progressive pallor and fatigue
• No hepatosplenomegaly
• Investigations showed microcytic hypochromic anemia with raised ESR and high serum ferritin (221).