Histology · Year 1 · from Histology
Case 1: Iron Deficiency Anemia
Clinical Image
Source: Wikipedia - Iron Deficiency Anemia - CC BY-SA 3.0
Case Presentation
A 34-year-old woman presents with fatigue, weakness, and exertional dyspnea that has progressively worsened over six months. She reports heavy menstrual periods lasting 7-8 days with clots. Physical examination reveals pallor of the conjunctivae and nail beds, and smooth, atrophic tongue (glossitis). Laboratory studies show: hemoglobin 8.2 g/dL (normal 12-16), MCV 68 fL (normal 80-100, indicating microcytosis), MCHC 28 g/dL (normal 32-36, indicating hypochromia), serum ferritin 8 ng/mL (normal >12), serum iron 25 mcg/dL (normal 60-170), and elevated TIBC 450 mcg/dL (normal 250-370). Peripheral blood smear reveals microcytic, hypochromic red blood cells with increased central pallor, anisocytosis (variation in size), and occasional "pencil cells" (elongated elliptocytes). She is diagnosed with iron deficiency anemia secondary to menorrhagia and started on oral iron supplementation. Gynecologic evaluation is arranged.
Key Learning Points
- Iron is essential for hemoglobin synthesis; deficiency produces small (microcytic) and pale (hypochromic) red blood cells
- Normal RBC central pallor occupies approximately one-third of the cell; in hypochromia, it expands significantly
- The blood smear shows characteristic findings: microcytosis, hypochromia, anisocytosis, and pencil cells
- Iron studies show low serum iron and ferritin with elevated TIBC (the body's attempt to capture more iron)
- Identifying the underlying cause of iron loss (menorrhagia, GI bleeding, malabsorption) is essential