Up to which limit can one survive with iron deficiency anemia ?

J Clin Exp Invest www.clinexpinvest.org Vol 1, No 3, December 2010 Yazışma Adresi /Correspondence: Assist. Prof. Dr. Mehmet Vural, Department of Obstetrics and Gynecology, School of Medicine, Harran University, Sanliurfa, Turkey Email: drmvural@yahoo.com Geliş Tarihi / Received: 10.07.2010, Kabul Tarihi / Accepted: 28.10.2010 Copyright © Klinik ve Deneysel Araştırmalar Derg si 2010, Her hakkı saklıdır / All rights reserved Klinik ve Deneysel Araştırmalar Dergisi / Cilt/Vol 1, No 3, 226-227 Journal of Clinical and Experimental Investigations


INTRODUCTION
Severe iron deficiency is relatively low as compared to mild-to moderate iron deficiency anemia.In this paper we want to share a very severe iron deficiency anemia with interesting aspects.

CASE
A 17-year-old female was referred to our hospital because of lethargy, fatigue, loss of appetite and severe debilitation, which was worsened during the last three months.The patient was moderately mentally retarded.She had tachycardia (130 beats per minute) and was pale in appearance.She described primary amenorrhea that was probably due to hypophyseal impairment and malnutrition.She was 41 kg in weight with a body mass index of 15 kg/ m 2 .Laboratory values were as follows: white blood cell counts (WBC) 4900 cells/mm 3 , hemoglobin 1.7 g/dl, hematocrit 6.36%, mean corpuscular volume (MCV) 48, platelets 124.000/mm 3 , ferritin 1, total iron binding capacity 470 and red cell distribution width (RDW) 75.Certain serum parameters are given in Table 1.
Serum Vitamin B12 and folate levels were within the normal ranges.On peripheral blood smear anisocytosis, significant hypochromia, and microcytosis were present.She was immediately transfused with two units of red blood cells and started on parenteral (intra-venous) iron-sucrose therapy (Venofer®).On the following days she was given two more units of erythrocyte suspension transfusions.Before discharge she was put on oral iron for six months.On the following visits the patient's symptoms including tachycardia, fatigue, and respiratory distress resolved at discharge (at 1 week).On a follow-up visit at 4 weeks she was doing well with normalized hemoglobin (12.1 g/dl) and ferri-

DISCUSSION
The main reason of reporting this patient was the unexpected severity of anemia.Unfortunately, mental retardation and malnutrition accompanied by the low socioeconomic circumstances of the family seem to have led to this situation.Because iron deficiency anemia is described as most common nutrition defect worldwide 1 , our case might represent an extremely severe malnutrition characterized by a hemoglobin measurement below 2 g/dl.In a recent study Lin et al. have showed that degree of disability has positive and body mass index has negative correlation with anemia in the population of the 937 children with intellectual disabilities. 2For this reason, mental retardation may be the main reason for chronic iron deficiency anemia in our patient.On the other hand the compensatory mechanism of the human body worth to be mentioned.Even in such low degrees of anemia, one can survive for months.
Ghosh et.al have revealed non hematological effects of the iron deficiency anemia and stated that iron deficiency can cause poor cortical arousal, diminished attention span, reduced scholastic performance in schools and reduced mental alertness. 3ost probably iron deficiency and mental retardation are in a vicious cycle.Our case also may be in such a condition.Blood transfusions might have some risks.Here, we have to emphasize the significance of avoiding unnecessary blood transfusions even in the setting of severe iron deficiency.Our case is practically is an exception and might illustrate the strength of compliance and compensatory mechanisms against severe anemia human body can compensate.

Table 1 .
(45 ng/ml) with no complaints.She goes on to come follow-up examinations.Because of all abnormalities were corrected by iron supplementation, no further work-up was performed.Certain serum parameters of our patient.
J Clin Exp Invest www.clinexpinvest.orgVol 1, No 3, December 2010 tin levels *Reference values are for the follicular phase of the menstrual cycle.