A 52 year female wid breathlessness n retrosternal chest pain along wid burping since 1 year. No other specific complaints. No particular family history. Neither diabetic nor hypertensive. Vitals stable. ECG was like low voltage complexes and small amplitude p waves Cxr normal ECHO - mild TR. Normal LV function. USG normal CBC - 6.1 Hb With MCHC pattern. Iron studies r in d picture given. Kindly suggest a better option of treatment my dear doctors.

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Breathlessness is due to severe anemia. Chest pain may be due to peptic ulcer or gastric carcinoma causing chronic blood loss leading to iron deficiency anemia. Do an UGI endoscopy, stool occult blood & dc, tlc to see for eosinophilia . Correct iron deficiency with oral iron supplement or with iv if patient is not tolerating oral iron. Treat according to etiology.

This is a case of Severe Anaemia secondary to occult Blood loss with Most probably Impending CCF (evaluate clinically for signs of HF) Any h/o bleeding PR? Any h/o of Nsaids abuse? Platelets and coagulation profile? Advice for Haematocrit Corrected Reticulocyte index Liver function tests Renal functions Stool examination for Occult blood Gastroscopy If possible PR examination followed by Colonoscopy if any. Main aim is to evaluate for the underlying cause of blood loss. Transfuse her with 3 to 4 units of Packed Red cells (PRC'S) and build Hb above 9gm% followed by Ferrous carboxymaltose or Iron Isomaltoside injection depending on Fe requirement of the patient . PPI administration. Subsequently finding the underlying cause and treating it.

Excellent approach sir

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