A 61 year old female with evidence for sepsis, anaemia and dehydration

1.

Microcytic hypochromic anaemia

Fe deficiency with elevated Ferritin

Obstructive picture on LFT without jaundice

normal electrolytes

2.

Sepsis – ?liver /gallbladder source, other

(CRP was 325)

Dehydration – high urea

Fe deficiency anaemia with acute illness (Ferritin is an acute phase reactant)

Anaemia of chronic disorder:

Autoimmune – Crohn’s, SLE, RA, Ulcerative colitis

Cancer – Lymphoma, Hodgkin’s

Chronic kidney disease

Chronic Inflammation – Infective endocarditis, osteomyelitis, TB, HIV, Hepatitis C

So far, all the investigations in this lady have failed to reveal a cause for iron defiency and the elevated Ferritin was thought to be an acute phase reactant

3.

ACD                                                      Fe deficiency

Type of Anaemia               80% normocytic                                   microcytic

normochromic                                  hypochromic

MCV                                            N                                                          low

MCH                                            N                                                          low

Transferrin                                 low                                                        high

Transferrin Sats                         low normal                                             low

Ferritin                                         high                                                      low

ESR                                           may be high                                           low

Bone Marrow Iron                           high                                                   low