Anaemia in a child with chronical disease and a newly diagnosed hypoparathyreosis

Anemia of chronic patients is a secondary hematological syndrome, and most often accompanies infectious-inflammatory, immunopathological and tumor processes. The introduction discusses the importance of blood testing to assess the response of the immune and hematopoietic systems to various adverse effects. Various mechanisms are involved in the pathogenesis of anemia, among which the main place belongs to the action of proinflammatory cytokines. In many cases, sideropenia develops that is not associated with an absolute iron deficiency, but occurs as a result of the redistribution of iron reserves in the body. In some patients, diagnosis of various types of pathology begins with the detection of anemia. This requires a comprehensive examination of patients, the exclusion of primary hematological pathology and the detection of all concomitant diseases, including foci of infection. This article presents a clinical example of a multidisciplinary approach to the diagnosis of normochromic normocytic anemia, which resulted in the detection of endocrine pathology — hypoparathyroidism, and chronic foci of Epstein–Barr virus and streptococcal infection in a teenage girl. The peculiarity of the case was that the patient initially consulted a hematologist about mild anemia, but during the examination it became obvious that complaints of progressive weakness, fatigue, hand tremors, and dizziness could not be linked to the existing hematological pathology. Spastic disorders and tetany of the limb muscles that arose during the examination period became the reason for diagnosing metabolic disorders: determining creatine phosphokinase, serum myoglobin, blood electrolytes, including calcium and phosphorus, as well as hormones of the thyroid and parathyroid glands. The examination results showed that the severity of the girl’s condition and neurological symptoms were caused by severe metabolic changes, phosphorus-calcium metabolism disorders in the form of hypocalcemia, hyperphosphatemia, increasing levels of creatine phosphokinase, high levels of lactate dehydrogenase, and were due to endocrine pathology. The presence of neurological symptoms, changes in magnetic resonance imaging and electrocardiogram against the background of a significant decrease in parathyroid hormone, hypocalcemia, and increasing levels of creatine phosphokinase required the patient to be referred to the hospital with a diagnosis of “Hypoparathyroidism”. The presented clinical case confirms the need for an individual, multidisciplinary approach to the diagnosis of secondary anemic conditions, which will allow identifying pathology of various organs and systems.