A 60 years old male came to the clinic with chief complaint of weakness.He had prolonged symptoms of epigastric pain and need antacid forrelieving it. He has suffered from rheumatoid arthritis since five yearsago and always taken Non Steroidal Anti Inflammatory Drugs.
Physical Examination :
General appearance : pale, fatiqueHR : 94 X/minute, RR:24 X/minute, Temperature: 36,8
C, BP : 110/60mmHgCheilitis positiveKoilonychias positive
Hemoglobin is 5,0 g/dl, mean corpuscular volume (MCV) is 70 fL, MCH25, MCHC 30%, RDW: 17, blood smear : anisocytosis, hypochromemicrocyter, poikilocytosis.Fecal Occult Blood : positive
Fe serum 8 µg/dL ( normal 50-150µg/dL )TIBC 450µg/dL ( normal 250-370µg/dL )Saturation 1,7% ( normal 20-45% )Ferritin 10µg/dL ( normal 15-400µg/dL )