## 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

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### 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).