P1425 - An Unusual Case of Iron Deficiency Anemia

Anuj Shah, MBBS¹, Manoj Ghoda, MD^2
1Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; ²Private Clinic, Ahmedabad, Gujarat, India

Introduction: Iron deficiency anemia is extremely common. But here we present a case of severe iron deficiency anemia where extensive investigations initially failed to identify the cause. It was only through serendipitous events that we discovered the underlying issue.

Case Description/Methods: A 24-year-old woman presented to the emergency department with severe right upper quadrant pain. She had a four-year history of feeling weak and breathless, and was diagnosed with anemia, initially treated with iron and vitamins. Despite treatment, her condition did not improve, and her hemoglobin level dropped to 3.7 g/dL. After receiving intravenous iron, her hemoglobin temporarily increased, but dropped again six months later. Further investigations revealed severe iron deficiency anemia with normal serum B12 and folate levels. Extensive tests, including fecal occult blood tests, upper GI endoscopy, colonoscopy, and duodenal biopsy, showed no abnormalities.
A contrast-enhanced CT angiogram revealed a hypervascular tumor supplied by peripheral arteries and central hemorrhage. This was suggestive of Hepatic Adenoma with central intralesional hemorrhage which was causing the iron deficiency anemia through hepcidin overproduction, which was confirmed by elevated serum and urinary hepcidin levels.
The patient underwent surgery to remove the tumor, whose features were consistent with hepatic adenoma. Post surgery a complete hematological recovery was seen. Six months post-operation, her hemoglobin level was 11.9 g/dL with normal indices and peripheral smear.

Discussion: Iron deficiency anemia is common and typically caused by nutritional deficiencies, parasitic infestations, heavy menstruation, certain medications, or mucosal lesions like ulcers or malignancies. Generally, a thorough history, physical examination, and standard investigations reveal the cause. However, in this young woman's case, none of these common causes were present.
Her hepatic adenoma (HA), a rare cause of iron deficiency anemia, was only detected when it became symptomatic. Hepcidin-secreting HA are particularly uncommon and often remain undiagnosed until complications arise, such as intralesional hemorrhage. Mild liver enzyme elevations noted earlier were not significant enough to prompt further investigation without liver-related symptoms. While HA is more frequently seen in young women on oral contraceptive pills (OCPs), this patient's case was rare as she was not on OCPs.


Disclosures:


Anuj Shah, MBBS¹, Manoj Ghoda, MD². P1425 - An Unusual Case of Iron Deficiency Anemia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.