A 55-year-old male is being evaluated for constipation. There is no history of prior gastrectomy or of upper GI symptoms. Hemoglobin is 10 g/dL, mean corpuscular volume (MCV) is 72 fL, serum iron is 4 μg/dL (normal is 50 to 150 μg/dL), iron-binding capacity is 450 μg/dL (normal is 250 to 370 μg/dL), saturation is 1% (normal is 20 to 45%), and ferritin is 10 μg/L (normal is 15 to 400 μg/L).

A 55-year-old male came to the clinic with complaint of exhausted. He had upper GI symptoms and always taken antacid for several years. He has suffered from rheumatoid arthritis since five years ago and always taken Non Steroid Anti Inflammatory Drugs.

Physical examination:General appearance: pale, fatique,HR: 68 x/minute, RR: 22 x/minute, Temperature: 36,8 C, BP : 120/80 mmHgLiver and spleen normal, No Lymphadenopathy, Epigastric pain.Cheilitis positiveKoilonychias positive

Laboratory Hemoglobin is 5,8 g/dL, mean corpuscular volume (MCV) is 70 fL, MCH 25, MCHC 30%, blood smear : anisocytosis, hypochrome microcyter, poikylocytosisFecal Occult Blood : positive

Othersserum iron is 8 μg/dL (normal is 50 to 150 μg/dL), iron-binding capacity is 450 μg/dL (normal is 250 to 370 μg/dL), saturation is 1,7% (normal is 20 to 45%), ferritin is 10 μg/L (normal is 15 to 400 μg/L).

Differential diagnosis :

Iron deficient anemiaAnemia of chronic diseaseThalassemiaAncylostomiasisChronic Kidney Disease

Questions:1. What do you thing about this man suffered from?2. What is the most likely diagnosis?3. What is differential diagnosis of this case?4. How to manage this patients?

Learning objectives :

1. To explain about iron metabolism2. To understand about the pathophysiology of hypochrome microcytic anemia3. To make the diagnosis and differential diagnosis of iron deficient anemia4. To understand about the management of iron deficient anemia

Term clarification :1. complaint of exhausted.2. gastrointestinal symptoms3. antacid4. rheumatoid arthritis5. NSAIDs

Problem identification :1.2.