A young man with anemia and recurrent tachyarrhythmic episodes

摘要

A 22-year-old Caucasian, male, nonsmoking, overweight welfare worker (body mass index 28.7) with personal anamnesis of recurrent hematochezia episodes interpreted as plausible chronic inflammatory bowel disease was admitted to the Emergency Department complaining of general asthenia without any other symptoms. During hospitalization, his tympanic temperature was 36.4° C, blood pressure was 130/70 mm Hg and SpO2 97% in room air. Physical examination revealed that oral mucosa, ocular conjunctivas and nail beds were pale. Thoracoabdominal objective examination presented regular results. No other abnormalities were reported. Laboratory analysis showed: white blood cells of 6.5 x 103/|il, hemoglobin (Hb) 4.9 g/dl, mean corpuscular volume 60.6 fl, mean corpuscular Hb (MCH) 16.8 pg, MCH concentration 2.7 g/dl and platelets of 351 x 103/|il. The patient was transferred to the Internal Medicine Ward in order to allow an in-depth evaluation. The following laboratory parameters were assessed during hospitalization: serum iron21 ng/dl (normal values 37-181 ug/dl), LDH 377 U/l, normal values for vitamin D and folic acid, transferrin and ferritin, electrolytes, erythrocyte sedimentation rate 28 mm/h, normal total bilirubin, serum creatinine 0.65 mg/dl, total protein 7.1 g/dl, normal IgA, IgM and IgG concentrations and serum albumin of 3.4 g/dl. Anti-glia-din antibody tests were negative, but the IgA endomysi-um assay and anti-tissue transglutaminase antibody tests were not performed. Urinalysis was negative.