Iron Deficiency Anemia as the Warning Sign of Carcinoma of Colon

Abstract

          The common cause of microcytic anemia is iron deficiency and its most frequent cause of deficiency is the occult iron loss from the lesions in the gastrointestinal tract especially in men and menopausal women. Herein we report a case of 74-year old German man who presents with progressive fatigue for a few weeks. The physical examination reveals only pallor. The blood tests show Hb 8.4 g%, MCV 67.1 fL, MCH 20.5 pg, RDW 16.0 %, ferritin 12.8 ng/mL, serum iron 21 ug/dL, TIBC 362 ug/dL,  transferrin saturation 6 %, CEA 18.68 ng/mL. He is definitely diagnosed as iron deficiency anemia (IDA) and treated with oral iron tablets. Six weeks later, he complains of abdominal pain and palpates the mass at the left upper quadrant while the anemia becomes more obvious, Hb 6.0 g%, ferritin 62.8 ng/mL, CEA 297.39 ng/mL. The left half colectomy and the adjacent lymph nodes resection are performed and the microscopic pathology of the colon is the poorly differentiated adenocarcinoma with the lymph nodes metastasis. This patient still encourages that when the case of IDA is encountered, the meticulous gastrointestinal tract study cannot be ignored or delayed even though such patient does not complains of any gastrointestinal symptom or the serum CEA is just slightly elevated. Otherwise, the serious cause of iron loss such as cancer of the gastrointestinal tract may be overlooked.