P3432 - Iron Deficiency Anemia: A Rare Trifecta

Adam Harris, ¹, Anita Vincent, MBBS², Tresa Alex, ³, Harris Naina, MD⁴, Samar Harris, MD^5
1Highland Park High School, Dallas, TX; ²Karnataka Institute of Medical Sciences, Hubli, Karnataka, India; ³TAMU, College Station, TX; ⁴Texas Oncology, Fort Worth, TX; ⁵Digestive Health Associates Texas, Dallas, TX

Introduction: In a recent analysis of global anemia burden, it estimated that over 30% of the world's population is anemic, the majority being due to iron deficiency anemia. There are several causes of iron deficiency anemia, here we present 3 causes in one patient.

Case Description/Methods: A 58 year old lady with a past medical history of hypertension and Type 2 Diabetes Mellitus on Farxiga and Metformin, was referred to the Gastroenterology Clinic for iron deficiency anemia. Her hemoglobin was noted to be 8.2 gm/dl, with an MCV of 73, ferritin was 5 with an elevated TIBC consistent with iron deficiency. She was also found to have a low Vit B12 at 221. She was started on oral replacement therapy with iron then switched to Ferumoxytol infusion and on oral sublingual formulation of Vitamin B12 1000 mcg.
On initial evaluation, she noted recent constipation. She denied a family history of GI malignancies. Blood work revealed an elevated TTG IgA Ab > 1:250 ( normal < 15) , elevated Anti endomysial Ab, along with elevated Anti intrinsic factor Antibody and Anti Parietal Cell Antibody.

She underwent an upper endoscopy with scalloping of mucosa in the duodenum, atrophic appearing gastric mucosa. Biopsies from the duodenum revealed increased intraepithelial lymphocytosis and complete villous blunting consistent with celiac disease. Biopsies from the stomach revealed chronic atrophic gastritis and ECL hyperplasia consistent with autoimmune metaplastic atrophic gastritis. She was unable to complete her colonoscopy due to poor prep. A CT scan of the abdomen pelvis with oral and IV contrast showed a 5 cm long concentric mass in the sigmoid colon as well as 3 poorly defined liver lesions concerning for metastases. She underwent a colonoscopy which showed a near obstructing sigmoid mass which could not be traversed. Biopsies confirmed adenocarcinoma and she subsequently underwent low anterior resection with pathology revealing invasive adenocarcinoma, moderately differentiated measuring 4.5 cm involving the rectosigmoid colon. CT-guided biopsy of the liver lesions confirmed metastatic adenocarcinoma compatible with colon primary. She was started on treatment with FOLFIRINOX/Avastin we will plan for 6 months of chemotherapy followed by liver resection if there is good response. She continues on a gluten-free diet, IV iron and Vit B12 injections.

Discussion: We would like to highlight the importance of investigating iron deficiency anemia with both laboratory and bidirectional endoscopy to ensure no etiologies are missed.


Disclosures:


Adam Harris, ¹, Anita Vincent, MBBS², Tresa Alex, ³, Harris Naina, MD⁴, Samar Harris, MD⁵. P3432 - Iron Deficiency Anemia: A Rare Trifecta, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.