Rocha Michaels C, Kamrul R and Rehman HU*
Department of Medicine,Regina Qu'Appelle Health Region, Regina General Hospital, 1440-14th Avenue, Regina, SK, S4P 0W5, Canada
Received: 16 October, 2014; Accepted: 08 November, 2014; Published: 10 November, 2014
Dr. HU RehmanClinical Associate Professor, Department of Medicine,Regina Qu'Appelle Health Region, Regina General Hospital, 1440-14th Avenue, Regina, SK, S4P 0W5, Canada, Email:
Rocha MC, Kamrul R, Rehman HU (2014) Iron Deficiency Anemia in a Premenopausal Woman. Global J Med Clin Case Reports 1(2): 043-045.
© 2014 Rocha MC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A 47-year-old woman presented to her family physician with complaints of persistent fatigue of three months duration. She had menorrhagia, irregular menses and mild dysmenorrhea but denied dyspnea, weight loss, fevers, night sweats, melena stool, overt rectal bleeding, hematuria, hematemesis and abdominal pain. She did not smoke and drank socially.
She looked pale on examination. Blood pressure was 141/77 mmHg, heart rate 114/min, temperature 36.6 C, and oxygen saturation while breathing room air was 99%. Gynecological examination was not performed. Her medical history was remarkable for recent diagnoses of iron deficiency anemia, chronic hyponatremia since age 26 and depression treated with Paroxetine. She was not taking aspirin or NSAIDS.
Her complete blood cell count revealed hemoglobin of 7.3g/dL, MCV 74.0 fL and RDW 16.6. Hemoglobin was 12.4g/dL 8 months before presentation. Urea nitrogen (BUN), creatinine and electrolytes were within normal limits. Pregnancy test and urinalysis were not performed.
She was transfused with 3 units of packed red blood cells. Esophagogastroduodenoscopy, colonoscopy and capsule endoscopy did not identify any source of bleeding. Gastric biopsies were negative for Celiac disease. Therapeutic course of iron was commenced and a follow up arranged.
Given the history of menorrhagia and dysmenorrhea and the fact that GI causes of anemia were ruled out, she underwent pelvic ultrasound. It showed an enlarged right ovary measuring 6.4x5.9cm. The patient was referred to a gynecologist. On gynecological examination, external genitalia, vaginal vaults, introitus, and cervix were unremarkable. A mobile mass was palpable in the right adnexa. MRI revealed a 7.3x7.2x6.1cm mass lesion containing solid and cystic components. There was a large hemorrhagic component to the lesion, appearances strongly suggestive of a malignant ovarian cancer.
A diagnostic laparoscopy was undertaken. Genital tract was found normal and the presumed ovarian mass was actually a pedunculated lesion measuring 7-8cm arising from the small bowel. Mass was resected laparoscopically.
The pathology diagnosis was a Gastrointestinal Stromal Tumor (GIST) with surgical margins positive for tumor. A second operation was carried out for wedge resection of small bowel. She was referred to the oncologists for chemotherapy.
Iron deficiency (ID) is defined as the decrease of the total content of iron in the body. Iron deficiency anemia (IDA) occurs when ID is severe enough to reduce erythropoiesis. In the developed world IDA occurs in about 2 to 5% of men and postmenopausal women . In men and post-menopausal women IDA is most commonly caused by gastrointestinal blood loss . Other causes include malabsorption, blood donation, hematuria, and dietary deficiency. In premenopausal women, IDA is usually due to menstrual blood loss, increase demand in pregnancy and breast-feeding, and dietary deficiency or malabsorption most commonly caused by celiac disease. It is estimated that about 11%of women aged between 20 and 49 years have ID  (Table 1).
Initial evaluation should start with detailed history addressing all potential causes of IDA.