B2 Answers

B2 Fe Deficiency

A 26-year-old malnourished woman presented with a 4-day history of mouth pain and a 3-month history of fatigue, general malaise, and palpitations. Physical examination revealed pallor of the conjunctiva and nail beds, as well as as the following photo:


Name this condition.

Koilonychia


Laboratory studies revealed a hemoglobin level of 30 g per liter, a platelet count of 45,000 per cubic millimeter, and a leukocyte count of 4100 per cubic millimeter. More lab studies were not done due to financial restrictions in the Brazilian clinic you were working at. Knowing that the local area had a high prevalence of hookworm infection, what lab studies would you pursue if you could order more?

Iron StudiesB2 Fe Deficiency

A 26-year-old malnourished woman presented with a 4-day history of mouth pain and a 3-month history of fatigue, general malaise, and palpitations. Physical examination revealed pallor of the conjunctiva and nail beds, as well as as the following photo:


Name this condition.

Koilonychia


Laboratory studies revealed a hemoglobin level of 30 g per liter, a platelet count of 45,000 per cubic millimeter, and a leukocyte count of 4100 per cubic millimeter. More lab studies were not done due to financial restrictions in the Brazilian clinic you were working at. Knowing that the local area had a high prevalence of hookworm infection, what lab studies would you pursue if you could order more?

Iron Studies

A peripheral blood smear shows the following (see above):


Describe what abnormalities you see, if any.

The RBC's here are smaller than normal and have an increased zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).

What is your leading diagnosis? Two clinical features have already been mentioned. Name a third. Name 3 things that could cause it.

Iron deficiency anemia. PICA

What would you expect the following labs to show in your diagnosis?
Decreased MCV
Decreased serum iron, iron saturation
Decreased serum ferritin
Increased TIBC, RDW


Put the following Stages of the etiology of this patient’s disease.


Absent Iron Stores
Decreased serum ferritin
decreased serum iron
increased TIBC
decreased iron saturation
Normocytic normochromic anemia
microcytic hypochromic anemia


Intraoral examination revealed an abscess, which was drained. The patient underwent blood transfusion; the repeat hemoglobin level was 71 g per liter, and there was clinically significant improvement in her systemic symptoms.


In what form is Iron absorbed? Where is it mostly absorbed?

Iron is absobed in the ferrous form Fe 2+ in the duodenum.


Your patient starts to complain she has trouble swallowing solid objects, but is able to drink fluids. What new syndrome comes to mind and what other clinical features are a part of it?

Plummer-Vinson Syndrome: esophageal web, iron deficiency anemia, achlorhydria, glossitis, koilonychia

(Clinical Vignette Adapted from NEJM)