A 60 yr old female with H/O 8 blood transfusion In 2 years. Her II b- 60g/l ,, TLC-5800, plutelet-3.4 lakhs, MCV 60, RBC-2.1 Inkhs/mnul. He Is having hypochromic microcytic anemia. Which Investigation Is not needed -
Clinically, IPH manifests as a triad of haemoptysis, diffuse parenchymal infiltrates on chest radiographs, and iron deficiency anaemia. It is diagnosed at an average age of 4.5 plus or minus 3.5 years, and it is twice as common in females. The clinical course of IPH is exceedingly variable, and most of the patients continue to have episodes of pulmonary haemorrhage despite therapy. Death may occur suddenly from acute pulmonary haemorrhage or after progressive pulmonary insufficiency resulting in chronic respiratory failure. There are several methods available for diagnosing and monitoring hemosiderosis including: Serum ferritin Liver biopsy MRI Serum ferritin is a low cost, readily available, and minimally invasive method for assessing body iron stores. However, the major problem with using it as an indicator of hemosiderosis is that it can be elevated in a range of other medical conditions unrelated to iron levels including infection, inflammation, fever, liver disease, renal disease and cancer. While liver biopsies provide a direct measure of liver iron concentration, the small sample size relative to the size of the liver can lead to sampling errors given the heterogeneity of iron concentration within the liver. Fuhermore, the invasive nature of liver biopsy and the associated risks of complications (which can range from pain, haemorrhage, gallbladder perforation and other morbidities through to death in approx 1 in 10,000 cases) prevent it being used as a regular monitoring tool. MRI is emerging as an alternative method for measuring liver iron loading because it is non-invasive, safer and generally cheaper to perform than liver biopsy; does not suffer from problems with sampling variability; and can be used more frequently than performing liver biopsies. Ref Davidson 23rd edition pg 864
Evaluation for pulmonary hemosiderosis
Urinary hemosiderin
Bone marrow examination
Q1 endoscopy
Haematology