Evaluation for pulmonary hemosiderosis Anemia with low RBC count, microcytotosis and hypochromia point towards iron deficiency anemia. - "Bone marrow biopsy" in iron deficiency anemia demonstrates erythroid hyperplasia and micronormoblasts reaction. - Prussian blue staining of the bone marrow aspirate and smear and biopsy demonstrate absent of iron stores. The patient continue to have iron deficiency anemia despite the blood transfusions. - This suggests chronic blood loss leading to iron deficiency anemia. - Chronic blood loss can result .from GIT (melena hematemesis) pathology. - G.I. Endoscopy is done in these cases to rule out GIT pathway. Chronic blood loss may also result from hemolytic anemias. - "Hemosiderin in urine" is found in patients with intravascular hemolysis. - Most of the autoimmune hemolytic anemias cause extravascular hemolysis (urine hemosiderin is absent). - Intravascular hemolysis occurs in paroxysmal nocturnal hemoglobinuria. This leads to chronic iron deficiency anemia. - Hemosiderin is present in urine due to intravascular hemolysis. Urinary hemosiderin can differentiate b/w PNH and other autoimmune hemolytic anemias. Idiopathic pulmonary hemosiderosis - Idiopathic pulmonary hemosiderosis is a rare condition chaeracterized by repeated episodes of intraalveolar bleeding that lead to abnormal accumulation of iron as hemosiderin in alveolar macrophage and subsequent development of pulmonary fibrosis and anemia. - The clinical features are characterized by a triad of - Hemoptysis - Moderate to severe iron deficiency anemia. - Diffuse radiological abnormality Diagnosis in these cases is confirmed by - Iron stains of sputum aspiration of and biopsy. The patient in the question does not give any features that are suggestive of idiopathic pulmonary hemosiderosis. He does not require evaluation for pulmonary hemosiderosis.