Koilonychia in Iron-Deficiency Anemia Samad Ghaffari, M.D., and Leili Pourafkari, M.D August 30, 2018 N Engl J Med 2018; 379:e13 DOI: 10.1056/NEJMicm1802104 A 54-year-old woman presented to the primary care clinic [phòng khám ban đầu] with fatigue [mệt mỏi] and a 7-year history of intermittent hemorrhoidal bleeding [chảy máu trĩ] On examination [thăm khám], she appeared pale [nhợt nhạt] and had spoon-shaped nails (koilonychia) [móng lõm hình thìa] on the second and third fingers [ngón tay thứ 3] (Panel A) and the thumb [ngón tay cái] (Panel B) of both hands The laboratory evaluation [đánh giá cận lâm sàng (phòng thí nghiệm)] showed a hemoglobin level of 7.8 g per deciliter (normal value, 12 to 15), a mean corpuscular volume (MCV) [thể tích trung bình hồng cầu] of 66 fl (normal value, 80 to 95), a platelet [tiểu cầu] count of 550,000 per microliter (normal value, 150,000 to 400,000), an iron level of 23 μg per deciliter (normal value, 40 to 155), a ferritin level of ng per milliliter (normal value, 12 to 150), and a total iron-binding capacity [khả gắn sắt toàn phần] of 470 μg per deciliter (normal value, 250 to 400) The findings on upper gastrointestinal endoscopy [nội soi dày - ruột trên] and colonoscopy [nội soi đại tràng] were normal, except for the presence of hemorrhoids [trĩ] Because bleeding [chảy máu] from hemorrhoids does not typically cause this degree of anemia [thiếu máu], further evaluation for other causes of iron deficiency [sự thiếu hụt sắt] was undertaken Stool examination for ova [trứng] and parasites [kí sinh trùng] and laboratory testing for celiac disease were negative [âm tính], and results on abdominal ultrasonography [siêu âm bụng] were normal Koilonychia [móng lõm hình thìa] is associated with iron-deficiency anemia [thiếu máu thiếu sắt] and may also be hereditary [di truyền], idiopathic [vô căn], or associated with nail trauma [chấn thương móng] or solvent exposure [tiếp xúc với dung mơi] The first three digits may be preferentially affected The patient [bệnh nhân] was treated [điều trị] with oral iron supplementation [bổ sung sắt đường uống] At the 3-month follow-up, her fatigue had lessened, and her hemoglobin level had increased to 11.2 g per deciliter; however, her nails appeared unchanged Samad Ghaffari, M.D Leili Pourafkari, M.D Tabriz University of Medical Sciences, Tabriz, Iran ... testing for celiac disease were negative [âm tính], and results on abdominal ultrasonography [siêu âm bụng] were normal Koilonychia [móng lõm hình thìa] is associated with iron- deficiency anemia. .. 400) The findings on upper gastrointestinal endoscopy [nội soi dày - ruột trên] and colonoscopy [nội soi đại tràng] were normal, except for the presence of hemorrhoids [trĩ] Because bleeding [chảy... this degree of anemia [thiếu máu], further evaluation for other causes of iron deficiency [sự thiếu hụt sắt] was undertaken Stool examination for ova [trứng] and parasites [kí sinh trùng] and