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Subtle Clues, Devastating Disease

  • Ami Schattner
    Correspondence
    Requests for reprints should be addressed to Ami Schattner, MD, Department of Medicine, Hebrew University-Hadassah Medical School, Kaplan Medical Center, 76100 Jerusalem, Israel.
    Affiliations
    Department of Medicine, Laniado Hospital, Sanz Medical Centre , Netanya, Israel

    Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel

    Faculty of Medicine, Ariel University, Ariel, Israel
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  • Ina Dubin
    Affiliations
    Department of Medicine, Laniado Hospital, Sanz Medical Centre , Netanya, Israel

    Faculty of Medicine, Ariel University, Ariel, Israel
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  • Livnat Uliel
    Affiliations
    Faculty of Medicine, Ariel University, Ariel, Israel

    Imaging, Laniado Hospital, Sanz Medical Centre, Netanya, Israel
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Published:December 07, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.11.013
      A healthy 28-year-old mother of 3 referred herself to the hospital because of leg pain and was admitted. Examination and Doppler ultrasound showed only varicose veins, without deep vein thrombosis or plantar fasciitis, and pallor. Hemoglobin (Hb) was 3.9 g/dL (mean corpuscular volume 60.7 fL, mean corpuscular hemoglobin 14.7 pg, red cell distribution width 18.4%), with normal white blood cells/platelets. The previous count was performed on the birth of her youngest son, 1.5 years prior showing Hb 10.8 gr/dL (mean corpuscular volume 89.4 fL). She reported normal diet and menses, had no gastrointestinal complaints and no medications or relevant family history.
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