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Case 2: Recurrent Anemia in a 10-year-old Girl.

1. Uzma Rani, MBBS*
2. Aamer Imdad, MBBS*
3. Mirza Beg, MD*


 

1. *SUNY Upstate Medical University, Syracuse, NY.

A 10-year-old premenarchal girl presents to the emergency department with an episode of syncope. She has been feeling progressively more tired for the last week, and her mother noticed that she was pale. The girl has had intermittent headaches but no complaints of palpitations, weight loss, abdominal pain, or rectal bleeding. Her diet consists of vegetables and meat. She is taking oral iron supplements because she presented with similar symptoms 4 months ago and was found to have severe anemia (hemoglobin of 4.9 g/dL [49.0 g/L]). The cause of the anemia at that time was determined to be iron deficiency, based on peripheral blood smear, iron studies, and bone marrow examination. A stool guaiac test was negative and hemoglobin electrophoresis yielded normal results. After packed red blood cell transfusion, she was started on ferrous sulfate supplements. Her anemia responded to iron supplements; her hemoglobin 3 months later measured 11 g/dL (110 g/L). Her maternal uncle has aplastic anemia.

Physical examination findings today include: heart rate of 116 beats/min, respiratory rate of 28 breaths/min, blood pressure of 102/52 mm Hg, oxygen saturation of 100%, and body mass index of 15.3. The only finding of note on physical examination is conjunctival pallor. …