A case of severe anemia

Six days back, a 21 year old female presented to our department with yellowish discoloration of sclera and high colored urine since one month. She has episodes of low grade fever in the past one month. She also complained of shortness of breath for 3 days and two episodes of vomitings.
She complained of retro-sternal chest pain which did not radiate and it wasn't associated with palpitations, syncopal attacks, cough, swelling of lower limbs.

Upon probing further into her illness, she told that she had the yellowish discoloration of sclera since childhood and it has aggravated in the last one month. It was known that she used to have occasional episodes of pain in both knee and ankle joints bilaterally since six months. She also noticed that her skin complexion has darkened over the last six months especially on the dorsal aspects of upper limbs.

There's no H/o pain abdomen, loose stools, decreased urine output, burning micturition, itching.

Past history:
She used unknown herbal medication for jaundice one month back.
She is not a k/c/o hypertension, diabetes mellitus, Asthma, epilepsy, Pulmonary kochs, CVDs
No H/o previous surgeries or blood transfusions or usage of any drugs.

There are no similar complaints in the family.

Personal history:
She consumes mixed diet and has normal appetite.
Her bowel and bladder habits are normal.

On examination, 
Patient was lying supine on the examination couch.
Patient is conscious, oriented and afebrile.
Pallor +++;
Icterus+;
Hyperpigmentation of knuckles of both hands.
No Koilonychia, clubbing, cyanosis, lymphadenopathy or pedal edema.

Her vitals are; Pulse: 102 bpm measured in Rt radial artery. It was regular.
                        BP: 110/60 mmHg measured in Rt arm in supine position.
                   
                        CVS: S1 heard and loud P2 heard. Grade 1 flow murmur
.                       RS: 16 cpm. BLAE present and NVBS heard.
                        P/A: Soft. Tenderness in Rt Hypochondriac region. Bowel sounds are heard.
                        CNS: Higher mental functions are normal. No focal neurological abnormalities                                     detected



After examination, we began the work up for Anemia and jaundice.

Following investigations were sent. 



Hemogram

Blood samples for Iron studies and B12 estimation were sent
Later 3 units of packed RBCs were transfused.
Post transfusions hemogram


Other investigations as follows


















She was treated as a case of Dimorphic anemia.

Parenteral iron preparations and vitamin b12-Folic acid supplementations were given for the correction of her anemia.

She got discharged with oral iron preparations and vitcofol injections.
She came for followup after 14 days with the reports of complete hemogram which showed improved hemoglobin levels and also clinically improvement was good.

Your valuable inputs on this case are highly appreciated

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