Case Studies

Pregnant woman

A 31 year old woman in her third pregnancy was found to be anaemic during her routine blood test with the midwife at 28 weeks of pregnancy. She had assumed her exhaustion and difficulty sleeping was due to being pregnant and looking after her two young children. After an infusion of iron she felt much more able to cope and found she was sleeping better.

Young woman with heavy menstrual bleeding

A 35-year-old female presents with palpitations, weakness, and shortness of breath. She reports heavy menstrual bleeding since the birth of her second child 4 years ago. Laboratory tests reveal a haemoglobin level of 90 g/L, MCV of 65 fl, and ferritin level of 8 mcg/L. The diagnosis in this case is iron deficiency anaemia due to chronic blood loss from heavy menstrual bleeding.

She tried to take iron tablets but often forgot them and felt they were not working. She opted for an iron infusion for faster response and relief of symptoms.

Student unable to sustain concentration in final year of university exams

A 22-year-old male student presents with fatigue, weakness, and difficulty concentrating. He reports a poor diet consisting mainly of fast food, processed snacks, and minimal intake of fruits and vegetables. Laboratory tests confirm iron depletion. Fortunately he was not yet anaemic.

The cause of iron deficiency anaemia in this case was inadequate dietary intake of iron over extended periods. The poor diet lacking in iron-rich foods contributed to his iron deficiency. The student’s lifestyle may have led to neglecting proper nutrition, resulting in the development of iron deficiency anaemia and poor concentration levels leading up to a period of intensive degree exams.

Treatment involved iron supplementation to correct his anaemia and dietary modifications, including incorporating iron-rich foods into his meals. This could have been managed with iron tablets but he wanted faster resolution in order to be ready for his exams and so received an iron infusion. Education on the importance of maintaining a balanced diet and healthy lifestyle practices was provided to prevent future nutrient deficiencies and promote overall health.

Pre-operative anaemia

A 76 year old lady had been on the waiting list for hip replacement. At the pre-operative assessment clinic she was found to be anaemic with a Hb of 88 g/L. Further investigations confirmed this to be due to iron deficiency. Her operation was delayed as it was felt her health should be improved prior to surgery. She was given an iron infusion bringing her Hb to 106 g/L allowing surgery to proceed safely.

Post operative anaemia

A 50-year-old male with a history of gastric bypass surgery presents with fatigue, pale skin, and pica (craving and eating non-food substances like ice or dirt). Laboratory tests show a haemoglobin level of 85 g/L, transferrin saturation of 4% and serum ferritin level of 15 mcg/L. The diagnosis in this case was iron deficiency anaemia due to malabsorption after gastric bypass surgery. His symptoms improved after two infusions of intravenous iron.

Loss of feel-good vitality and looks

A 49-year-old lady reported thinning hair, brittle nails and dry skin over the last 6 months. She thought this may be starting the menopause. However further tests confirmed iron deficiency and after an iron infusion, the appearance of her skin, nails and hair improved.

Undergoing anti-cancer therapy

A 78-year-old man receiving anti cancer treatment was given repeated blood transfusions for anaemia and associated symptoms of breathlessness and exhaustion. Each transfusion gave him short-term relief but this didn’t last more than a few days. He had assumed his symptoms were related to the cancer but further investigations showed a functional iron deficiency, with Hb 79 g/L, transferrin saturation of 8% and serum ferritin 243 mcg/L. After two infusions of iron his transfusion requirements reduced by 80% and he was better able to cope with his anti-cancer treatment.

Patient with inflammatory bowel disease

A 44-year-old lady with longstanding ulcerative colitis had a flare up of her disease, with abdominal pains and passing blood. She experienced palpitations and breathlessness. Blood tests confirmed a functional iron deficiency, with Hb 112g/L, transferrin saturation 12% and serum ferritin 152 mcg/L. After an infusion of iron, her symptoms resolved within 2 weeks. Due to recurrent flares of her ulcerative colitis she required another iron infusion 8 months later.

Patient on aspirin and anticoagulants for heart disease

An 81-year-old man felt breathless and dizzy with cold hands and feet for the last 6 months. He had been on low dose aspirin since a cardiac bypass graft 12 years before and had been on dabigatran anticoagulant for atrial fibrillation. He reported passing black bowel motions suggesting blood loss from the upper gastrointestinal tract. Iron deficiency was confirmed, and an endoscopy was performed which showed gastritis. He received an iron infusion, the dabigatran was interrupted for a few days, aspirin was stopped and he was started on medication to heal his stomach. His symptoms improved after 5 weeks.

Endurance athlete

A 28-year-old male triathlete noticed his performance was deteriorating. Blood tests confirmed he had iron deficiency and endoscopy showed this was due to slow hidden bleeding from the stomach from excess use of non-steroidal anti-inflammatory drugs he’d taken for pain relief, as well as increased iron demands due to high intensity training. Treatment included intravenous iron infusion over 15 minutes, repeated after one week. He was given medication for his stomach, increased his consumption of iron-rich foods (especially animal sources) and had follow-up blood tests to check for recurrence. He noted improvement in fitness, strength and endurance soon after the second infusion.