Normocytic anaemia and thyroid function tests

Key words: Hypothyroidism, Hashimoto thyroiditis, Normo-macrocytic anaemia, Hyporegenerative anaemia

The paper describes the case of an 11-year-old girl presenting with normocytic hyporegenerative anaemia associated with increase of transaminases, CK and LDH. On physical exam skin pallor, mask-like facies and dry skin were observed; weight and height were below the third percentile for age and sex. Abdomen ultrasound (US) was significant for faecal impaction, but excluded an abdominal neoplasia. Lab tests showed persistency of normocytic anaemia while B12 and folate dosage, haemoglobin electrophoresis and DEB test were normal. However, a screening of thyroid function showed an abnormally high TSH and undetectable fT4 and fT3. Dosing of specific antibodies and thyroid US led to diagnosis of Hashimoto thyroiditis. Normocytic anaemia among paediatric patients cannot only be related to medullary aplasia, but also to chronic diseases and endocrinological disorders that should be adequately investigated. If the diagnosis still remains elusive, the execution of a bone marrow is mandatory.