20-year-old female present with features of anemia. Blood tests: Hb-5g/dL, MCV – 52 fL, MCH-22 pg, PCV – 15%. Diagnosis?
**Core Concept**
Microcytic anemia is characterized by low mean corpuscular volume (MCV) and is often caused by iron deficiency, thalassemia, or chronic diseases. However, in this scenario, the patient's low MCV (52 fL) and low hemoglobin (Hb) level (5 g/dL) suggest iron deficiency anemia, but the presence of hookworm infection can also lead to iron deficiency by causing chronic blood loss in the gastrointestinal tract.
**Why the Correct Answer is Right**
Hookworm infection (Ancylostoma duodenale or Necator americanus) leads to iron deficiency anemia due to the parasite's attachment to the intestinal mucosa and subsequent blood loss. The adult worms attach to the intestinal wall and suck blood, resulting in chronic blood loss, which can lead to iron deficiency anemia. This is a common cause of iron deficiency anemia in developing countries.
**Why Each Wrong Option is Incorrect**
**Option A:** Phenytoin toxicity is associated with macrocytic anemia, not microcytic anemia. Phenytoin interferes with folate metabolism, leading to a decrease in the production of red blood cells.
**Option B:** Fish tapeworm (Diphyllobothrium latum) infection leads to vitamin B12 deficiency, causing megaloblastic anemia, not microcytic anemia.
**Option D:** Blind loop syndrome is associated with vitamin B12 deficiency and can cause megaloblastic anemia, not microcytic anemia.
**Clinical Pearl / High-Yield Fact**
Hookworm infection can cause iron deficiency anemia, but it can also lead to malabsorption of other nutrients, including vitamin B12 and folate, due to the chronic inflammation and damage to the intestinal mucosa.
**✓ Correct Answer: C. Hookworm infection**