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Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 62-63

Anemic retinopathy as a presenting feature of severe dimorphic nutritional anemia in a young male patient after crash dieting

Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India

Date of Submission08-Aug-2021
Date of Acceptance21-Sep-2021
Date of Web Publication19-Jan-2022

Correspondence Address:
Dr. Abhilasha Sanoria
G-242, Sector 22, Noida - 201 301, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_90_21

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We report the case of a 31-year-old male patient who presented for a routine ophthalmological examination. Evaluation revealed the presence of bilateral flame-shaped hemorrhages and Roth's spots. Hematological evaluation revealed the presence of severe iron deficiency anemia with megaloblastic anemia. This case documents the occurrence of anemic retinopathy in dimorphic nutritional anemia after crash dieting (severe calorie restriction).

Keywords: Anaemic retinopathy, crash dieting, nutritional anaemia

How to cite this article:
Jain P, Sanoria A. Anemic retinopathy as a presenting feature of severe dimorphic nutritional anemia in a young male patient after crash dieting. Indian J Med Spec 2022;13:62-3

How to cite this URL:
Jain P, Sanoria A. Anemic retinopathy as a presenting feature of severe dimorphic nutritional anemia in a young male patient after crash dieting. Indian J Med Spec [serial online] 2022 [cited 2023 Mar 31];13:62-3. Available from: http://www.ijms.in/text.asp?2022/13/1/62/335974

  Introduction Top

Obesity has become a huge public health issue in the developed and developing countries. In view of the health hazards associated with obesity and more importantly for cosmetic reasons, many people, particularly the youth, have started resorting to “extreme” weight-loss diets to achieve a rapid reduction in weight. These extreme diets are either very low in carbohydrate or very low in fat.[1] In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Crash diet fads shock the body, sending it into starvation mode and this can have grave repercussions.

  Case Report Top

A 31-year-old apparently healthy married male presented to the OPD for a routine ophthalmological examination. He had no fresh visual complaints. His visual acquity was corrected to 6/6 with - 6 DS in both the eyes and conjunctival pallor was present. Fundus examination revealed the presence of multiple flame-shaped peripapillary hemorrhages, white centered and dot and blot hemorrhages and venous dilatation [Figure 1]. In view of the fundus findings, the patient was probed further, and he claimed that he had no systemic problems. He weighed 115 kg and was 6 ft tall. He admitted that he lost 25 kg in the last one month and was on a crash diet as he wanted to lose weight. Comprehensive blood investigations were advised which revealed the presence of a severe iron deficiency anemia along with Vitamin B12 deficiency [Table 1]. The peripheral blood smear showed the presence of anisopoikilocytosis, macrocytes, and few tear drop cells. He was treated with two units of packed cell transfusion with intravenous Vitamin B12 injection 1000 μg daily for 5 days, then every week intravenously for 1 month, then was advised to take injections once every 3 months for 2–3 years. Iron supplementation was also instituted. His hematological parameters improved over the next 1 month.
Figure 1: Fundus examination-multiple flame shaped peripapillary haemorrhages, white centered and dot and blot haemorrhages and venous dilatation

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Table 1: Investigations

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  Discussion Top

The pathogenesis of anemic retinopathy has been attributed to factors such as anoxia, venous stasis, angiospasm, and increased capillary permeability with a higher prevalence in patients with Hb <8 g/dl.[2],[3],[4],[5] There have been case reports of ocular manifestations of anemia documented in literature.[6],[7] The occurrence of iron deficiency anemia along with megaloblastic anemia with thrombocytopenia in our patient was worsened by A crash diet in which the patient had severly restricted his calorie intake to less than a 1000 calories/day. Our case demonstrates the harmful effects of a crash diet as the patient was totally unaware that he had developed severe anemia. It was during a routine examination that the anemic retinopathy was picked up. The patient might have developed a severe vision loss and other secondary systemic problems if the treatment would not have been instituted early.

  Conclusion Top

Crash dieting can cause serious eating problems and a variety of disorders such as anorexia and bulimia.[8] Its risks for the long-term include osteoporosis from calcium deficiencies, brain damage, liver and/or kidney failure, heart attack, and stroke.[4] It is thus, a major public health problem and warrants immediate attention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Joshi S, Mohan V. Pros and cons of some popular extreme weight-loss diets. Indian J Med Res 2018;148:642-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
Carraro MC, Rossetti L, Gerli GC. Prevalence of retinopathy in patients with anemia or thrombocytopenia. Eur J Haematol 2001;67:238-44.  Back to cited text no. 2
Markar MA, Peiris JB, Silva GU. Retinopathy in megaloblastic anemias. Trans R Soc Trop Med Hyg 1969;63:398-406.  Back to cited text no. 3
Duke-Elder S, Dobree JH. Disease of Retina; lx. System of Ophthalmology. Ch. 4. United States: C.V. Mosby Co; 1967. p. 373-81.  Back to cited text no. 4
Rubenstein RA, Yanoff M, Albert DM. Thrombocytopenia, anemia, and retinal hemorrhage. Am J Ophthalmol 1968;65:435-9.  Back to cited text no. 5
Lam S, Lam BL. Bilateral retinal hemorrhages from megaloblastic anemia: Case report and review of literature. Ann Ophthalmol 1992;24:86-90.  Back to cited text no. 6
Foulds WS. The ocular manifestations of blood diseases. Trans Ophthalmol Soc UK 1963;83:345-60.  Back to cited text no. 7
Di Vetta V, Clarisse M, Giusti V. Hypocaloric diets: Which ones to advise/avoid? Rev Med Suisse 2005;1:818-22.  Back to cited text no. 8


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  [Table 1]


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