Anaemia in Waldmann’s disease: A rare presentation of a rare disease

Table 1 Laboratory results for the patient

Test	Result	Normal reference
Complete blood count
Hemoglobin	5.2 g/dL	12-18 g/dL
HCT	18.30%	37%-51%
MCV	70.2 pg	80-97 flpg
MCHC	28.4 g/dL	31-36 g/dL
Platelets	284	140-440 cell/cm3
WBCs	3.8	4.1-10.9 cell/cm3
Lymphocytes	500	600-1400
Blood film
Hypercellular bone marrow with no blast cells
Blood chemistry
s. Albumin	2.1 g/dL	3.5-5 g/ dL
AST	30 IU/L	Up to 40 U/L
ALT	25 IU/L	Up to 45 U/L
s. cholesterol	107 mg/dL	Up to 200 mg/dL
s. triglyceride	54 mg/dL	Up to 160 mg/dL
s. iron	23 ng/dL	28-170 ng/dL
s. ferritin	12 ng/mL	40-430 ng/mL
TIBC	750 ng/dL	261-478 ng/dL
s. TSH	1.2 mIU/L	0.3-3.04 mIU/L
Stool tests
Occult blood	Positive
α-1 AT clearance	2 folds above normal range

HCT: Hematocrit; MCV: Mean corpusclar volume; MCHC: Mean corpuscular hemoglobin concentration; WBCs: White blood cells; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TIBC: Total iron binding capacity; TSH: Thyroid stimulating hormone; α-1 AT: Alpha 1 antitrypsin.

Table 2 Causes of protein losing enteropathy[1]

Erosive gastrointestinal disease

Inflammatory bowel disease

Gut malignancy

Non steroidal anti-inflammatory drug enteropathy

Erosive gastropathy

Acute graft vs host disease

Pseudomembranous enterocolitis

Ulcerative jejunoenterocolitis

Intestinal lymphoma

Sarcoidosis

Non erosive gastrointestinal disease

Celiac disease

Hypertrophic gastropathies

Eosinophilic gastroenteritis

Connective tissue disorders

Small intestinal bacterial overgrowth

Amyloidosis

Microscopic colitis

Tropical sprue

Whipple's disease

Parasitic diseases

Viral gastroenteritis

Increased interstitial pressure

Intestinal lymphangiectasia

Congestive heart failure

Constrictive pericarditis

Congenital heart diseases

Fontan procedure for single ventricle

Portal hypertensive gastroenteropathy

Hepatic venous outflow obstruction

Enteric lymphatic fistula

Mesenteric venous thrombosis

Sclerosing mesenteritis

Mesenteric tuberculosis or sarcoidosis

Neoplasia involving mesenteric lymph nodes or lymphatics

Chronic pancreatitis with pseudocysts

Congenital malformations of lymphatic

Retoperitoneal fibrosis