Chronic microcytic anemia and jaundice in a 36-year-old male of burmese descent

Abstract

Patient: A 36-year-old male of Burmese descent. Chief Complaint: Anemia and jaundice. History of Present Illness: At the time of presentation, the patient was a recent immigrant from Burma who wished to establish care with an American physician. He had been chronically jaundiced and anemic since childhood, with multiple episodes of severe anemia requiring transfusion. He reported receiving more than 30 units of blood prior to age 17. Past Medical History: The patient contracted hepatitis C secondary to blood transfusions he received in Burma. Folic acid was his only medication. He has no history of tobacco or alcohol abuse. Family History: The patient is married with 1 child and works as an accountant. His mother and 1 sister both have thalassemia, although they are not as severely affected as he is. His father and 3 brothers have no known hematologic disorders. Physical Examination: Upon presentation, the patient was a well-nourished, well-developed male appearing jaundiced. Nontender splenomegaly was noted extending to the level of the umbilicus. There were no other abnormal findings on physical examination. The following vital signs were recorded: blood pressure, 130/75 mm Hg; pulse, 72; and respiration rate, 16. Principal Laboratory Findings: Table 1 and Images 1-2. Additional Diagnostic Tests: Hemoglobin (Hb) analysis was performed by high performance liquid chromatography (HPLC). The results are shown in Figure 1.