Volume : 12, Issue : 02, February – 2025

Title:

A COMPLEX CASE OF IRON DEFICIENCY ANEMIA, AUTOIMMUNE HAEMOLYTIC ANEMIA, AND HASHIMOTO’S THYROIDITIS IN A POST-MENOPAUSAL FEMALE
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Authors :

Damini Kharb*, Shradha Rautela, Sakshi Singh, Diksha Joshi, Himanshi Chauhan

Abstract :

A 45-year-old post-menopausal female presented with generalized weakness and decreased appetite over the past 10 days. Her medical history included hypothyroidism, managed with THYRONORM 100 mcg OD BFF, and a history of anaphylactic reactions to iron. Initial laboratory investigations revealed severe anemia (Hb 5.5 g/dL), with microcytic and hypochromic indices, low serum iron (23 µg/dL), elevated total iron-binding capacity (443 µg/dL), and low ferritin (3.38 ng/mL), consistent with iron deficiency anemia (IDA). The absence of gastrointestinal bleeding (negative stool occult blood) suggested dietary insufficiency or malabsorption as the cause. Further evaluation revealed a positive Indirect Coomb’s Test, elevated lactate dehydrogenase (LDH), and splenomegaly, indicative of autoimmune hemolytic anemia (AIHA). Elevated anti-thyroid peroxidase (Anti-TPO) levels (7477.4 IU/mL) and thyroid ultrasound findings confirmed Hashimoto’s thyroiditis, contributing to her hypothyroidism. The coexistence of IDA, AIHA, and Hashimoto’s thyroiditis underscores the complex interplay of autoimmune and nutritional factors in this case. Differential diagnoses, including vitamin B12 deficiency and celiac disease, were ruled out based on normal vitamin B12 levels and negative tissue transglutaminase IgA (TTG). This case highlights the importance of a comprehensive diagnostic approach in patients with anemia, particularly when multiple autoimmune conditions are suspected. Management requires a multidisciplinary strategy, including cautious iron supplementation, thyroid hormone replacement, and monitoring for hemolysis. The presence of multiple autoimmune conditions in this patient emphasizes the need for ongoing surveillance and tailored treatment to address the underlying causes of anemia and associated comorbidities.
Keywords: Autoimmune Hemolytic Anemia (AIHA), Anemia of Chronic Disease, Coomb’s Test, Lactate Dehydrogenase (LDH).

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