urgent case

50 yrs old male no previous co morbid but every year since 4 years h/o iron transfusion,now came with fatigue and weakness And as per history on and off hematuria when he feels feverish some times. On examination- pallor,icterus HEMOGRAM-6.5gm ,reticulocyte count 1.8(uncorected),RDW -HIGH,peripheral smear - dimorphic,pencil cells,microcytic and macrocytic anemia.no atypical other cells LFT-total bilirubin raised,ALP raised more Usg abd- hepato splenomegaly Hiv,HCV,HIV-NR ESR-110, LDH- 900(high),thyroid profile-normal Coombs test - negative Iron profile-normal iron,TIBC,saturation and high ferritin B12- very high CUE-yellow but no bile pigments ANA profile reports- negative what is the further approach Hemoglobin electrophoresis and bone marrow biopsy not available here.. So what could be the diagnosis and further approach?



It may be a case of sideroblastic anemia with multisystem involvement.Suggest bone marrow examination to see for ring sideroblast

Thank you doctor

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