Koilonychia in iron deficiency

A 58-year-old male who was vegetarian by diet, with no previous comorbidities, presented with easy fatigability, dyspnoea on exertion and palpitations of 5-months duration. On examination, he had conjunctival pallor and spooning of multiple nails (Figure 1A). Rest of systemic examination was within normal limits. Investigations revealed haemoglobin of 95  g/l, mean corpuscular volume of 64.2 fl and peripheral blood film showed microcytic hypochromic anaemia with pencil cells and teardrop cells. Iron profile showed serum iron of 23 mcg/dl (normal 50–150 mcg/dl), total iron binding capacity 508 mcg/dl (normal 250–400 mcg/dl), percentag e transferrin saturation 5% (normal 14–50%) and serum ferritin of 4 mcg/l (normal 24–336 mcg/l) confirming the diagnosis of severe iron deficiency anaemia. Etiological evaluation for iron deficiency anaemia showed negative stool parasites and occult blood with the normal colonoscopic study. Upper gastrointestinal endoscopy revealedHelicobacter pylori positive chronic active gastritis. Celiac disease serology was negative. Other biochemical, autoimmune and radiologic evaluations were unremarkable.
Source: QJM - Category: Internal Medicine Source Type: research