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A puzzling case of anemia.

Salim A Haddad1, Karen K Winer, Anurag Gupta

  • 1Department of Transfusion Medicine, National Institutes of Health, Warren G. Magnusson Clinical Center, Bethesda, Maryland 20892, USA. shaddad@mail.cc.nih.gov

Transfusion
|December 11, 2002
PubMed
Summary

Munchausen syndrome, a form of fabricated illness, can cause unexplained anemia in young female healthcare professionals. Early diagnosis of this self-inflicted blood loss is crucial to prevent severe health issues and unnecessary medical interventions.

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Area of Science:

  • Internal Medicine
  • Hematology
  • Psychiatry

Background:

  • Iron deficiency anemia in adults is commonly caused by chronic blood loss.
  • Sudden, severe drops in hemoglobin (Hb) necessitate thorough clinical evaluation to identify the source of bleeding.

Observation:

  • A 39-year-old woman with refractory hypoparathyroidism presented with severe, unexplained anemia.
  • Despite multiple red blood cell (RBC) transfusions, her hemoglobin levels continued to drop without evidence of blood loss or hemolysis.
  • Extensive investigations failed to reveal an occult bleeding source.

Findings:

  • Laboratory values indicated an iron-deficient state.
  • The patient confessed to self-inflicted blood loss by drawing blood from her catheter.
  • This behavior is consistent with Munchausen syndrome, also known as factitious disorder imposed on self.

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Implications:

  • Munchausen syndrome should be considered in unexplained anemia, particularly in young female healthcare professionals.
  • Early diagnosis can prevent patient morbidity, reduce hospitalizations, and avoid invasive diagnostic procedures.
  • This case highlights the importance of considering psychological factors in complex medical presentations.