SEVERE IRON DEFICIENCY ANEMIA CAUSING PERICARDIAL EFFUSION

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pericardial effusions are caused by numerous etiologies including metabolic, cardiac disease, infection, neoplastic, or idiopathic. They may be isolated part a systemic illness. Severe iron deficiency anemia causing pericardial effusion has been rarely reported is not well studied1. CASE PRESENTATION: A 48-year-old female without significant past medical history presented with shortness breath exercise intolerance. She five-month menometrorrhagia blood clots. Physical examination was for grade 3 systolic murmur pitting edema to the knees. Labs revealed hemoglobin 1.7 g/dL, hematocrit 6.3%, MCV 51, RDW 34.2, reticulocyte count 0.0245. Hemolysis markers were negative. transfused four units packed red cells. Iron studies collected prior administration transfusions, therefore, available review. However, peripheral smear demonstrated hypochromic microcytic cells anisocytosis, poikilocytosis, cigar which diagnostic anemia. received 1 g IV Dextran her presumed Echocardiogram moderate-large circumferential anterior posterior heart evidence tamponade. The location precluded pericardiocentesis. Other rheumatologic workup Her symptoms improved she transitioned oral supplementation at discharge 6.6 g/dL.Within three weeks infusion, normalized 12.3 g/dL. repeat echocardiogram months after presentation showed small effusion, markedly reduced from prior. During this period, readmitted new onset status epilepticus, thought due CNS vasculitis. DISCUSSION: In patient, subsequent hospitalization seizures highly suspicious vasculitis based on imaging, presentation, overall response steroids. Brain biopsy however negative While it possible that related an underlying autoimmune disorder, initial work up negative, did resolve treatment unlikely cause literature remains sparse only two case reports documented2. CONCLUSIONS: associated high output failure, pulmonary arterial hypertension, effusions3. differential diagnosis extensive should considered in each clinical context every patient. REFERENCE #1: Adler Y, Charron P, Imazio M, Badano L, Baron-Esqivias G, Bogaert J, et al. 2015 ESC Guidelines management diseases: Task Force Diagnosis Management European Society Cardiology (ESC). Heart Journal 2015;36(42):2921-2964. #2: Lakhotia Singh Pahadia H, Kumar Sanghvi S. severe India 2014;2(3):88-90. #3: Rhodes CJ, Wharton Howard Gibbs JSR, Vonk-Noordegraaf AV, Wilkins MR. hypertension: potential therapeutic target. Respiratory 2011;38(6):1453-1460. DISCLOSURES: No relevant relationships Anita Fei, source=Web Response Desire Guthier, Alisha Hossain, Bradley Lash, Emily Skutnik, Andrew Viscusi, Ali Yazdanyar,