20 year female with severe anaemia since 5 years, with h/o Menorrhagia and on repeated blood transfusions. The positive results in the investigations are as follows: RBC: 3.4 million cells/cu mm Hb: 5.3 gm%,PCV:20.7%, MCV: 60fl/l,Serum iron: 28mcg, total iron binding capacity:303 mcg/dl, Transferritin saturation: 9.2, Serum ferritin levels: 2.66ng/ml. Vitamin B12: 682pg/ml, Folic acid:> 20 ng/ml. PS: Microcytic hypochromic, moderate anisocytosis, few tear drop & leptocytes seen, no normoblasts/parasites. WBC: 4500,N -38% ,L 59 % Platelets: 3.4 lakhs/cumm.
ESR: 84 mm/hr. USG: Splenomegaly, 12 X 6 cm. Can you please guide me regarding the likely cause and regarding the management? What more investigations are needed?
