Case history
Case history #1
A 52-year-old woman with a history of rheumatoid arthritis reports gradual worsening of symptoms over the past 2 months, with fatigue, malaise, and increased stiffness of the wrists and joints of the hands. Physical examination is significant for warmth, tenderness, and synovial thickening in wrists, metacarpophalangeal joints, and proximal interphalangeal joints bilaterally. She takes non-steroidal anti-inflammatory drugs as needed. The complete blood count shows a drop in haemoglobin from 123 to 96 g/L (12.3 to 9.6 g/dL) over the last 3 months and a mean corpuscular volume of 77 fL.
Case history #2
A previously healthy 72-year-old man presents with fever, chills, cough, and shortness of breath. Chest x-ray shows a right-middle-lobe infiltrate. He is diagnosed with pneumonia and admitted for intravenous antibiotics. Blood cultures eventually grow Streptococcus pneumoniae. By day 3, he is afebrile, but his haemoglobin is 105 g/L (10.5 g/dL), a decrease from 124 g/L (12.4 g/dL) on admission and 135 g/L (13.5 g/dL) 1 month ago. He has no evidence of gastrointestinal blood loss or overt haemolysis. Red cell indices reveal a normocytic normochromic anaemia.
Other presentations
Occasionally, anaemia of chronic disease (ACD) is the only clue to an underlying inflammatory disorder. For example, normocytic normochromic or microcytic hypochromic anaemia discovered in an individual with non-specific signs and symptoms could be one of the findings of polymyalgia rheumatica. Likewise, an occult abscess or focus of osteomyelitis that is largely asymptomatic may present with ACD.
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