Cases of the Week: Anemia

In Burundi last week, a 30 year old female came to clinic complaining of fatigue, progressive weakness, and swelling in her hands and feet over several weeks. The medical student, Blaise, astutely noted severe pallor and a heart murmur on his exam of the patient and so we sent her to the lab to have her hemoglobin checked. We continued seeing patients and then took a short break for lunch. After lunch, I realized the lady had never returned from the lab. We looked for her name in the lab books but it seems she never went to have her blood drawn. Another medical student, Isaac, and I continued looking for the patient - I remembered she was wearing a bright orange dress, which was not very helpful as orange seemed to be the favorite color of most of the women we saw last week. But we eventually found her lying under a shawl on the grass outside the hospital. Evidently she lacked the funds for the lab tests but she also lacked the strength to walk home. We arranged with the finance department for her to have her blood drawn for free and the result was a hemoglobin of 1.7 (normal is ~12)! Amazing that she was walking and talking with such a low hemoglobin. Thanks to Isaac's quick actions, she was admitted to the hospital with blood transfusing (in picture below) within 30 minutes.
The next morning she was feeling much better and requested we evaluate her one year old child who had also been sick. We diagnosed him with severe acute malnutrition and admitted him for treatment. Unfortunately there was very little we could do to diagnose the cause of her severe anemia. And even if we had access to more lab tests, most of the causes could not be treated in that setting.

Patient #2 was a 19 year old I saw this week at Tenwek. She presented with a hemoglobin of 1.1! She, too, received a blood transfusion and felt like a new person with a hemoglobin of 6.5. In this case, though, we knew that her platelet count and white blood cell counts were also low. We performed a bone marrow aspiration and biopsy to determine the cause of her pancytopenia and hopefully to be able to offer treatment. That biopsy will be read by a pathologist at Kijabe, another mission hospital here in Kenya. If she has leukemia, she can be referred to an oncologist three hours away for chemotherapy. This picture was taken on the day of her discharge home.
We see a lot of patients both in Kenya and Burundi who present with advanced disease. I never saw a hemoglobin of 1.1 in the States! We are so thankful that blood is available and that such a simple treatment makes such a huge difference for these people. They would not live long with so little blood! But we also see how developed medical care in Kenya has become in comparison with a place like Kibuye in Burundi. The second patient has so many more options available to her for diagnosis and treatment. We hope that in the years to come, Kibuye, too, will be able to provide more advanced care for patients who need it. As these mission hospitals continue developing, though, we pray that all patients will continue to experience the love and compassion of Christ through the care they receive.