A CASE OF ISCHAEMIC STROKE IN A PATIENT WITH SEVERE ANAEMIA 
Margerison T, Edwards D, Mahmood S, Kee YK
Croydon University Hospital, Department of Stroke and Elderly Care Medicine, London, United Kingdom
Background and aims: We present the case of a 59 year old female, previously independent with a background of type-two diabetes and a repaired retinal detachment. She presented with breathlessness and confusion later found to have multiple infarcts on MRI.
Method: Initial blood results showed a severe normocytic anaemia in this patient with a haemoglobin count of 36 g/l. Initial CT head showed low areas of density in the white matter querying inflammation or infarction. MRI confirmed these to be areas of infarction. The patient was investigated thoroughly for a cause to these infarcts: ECG, CT CAP, vasculitis screen all of which came back negative. Alongside this she was investigated for causes of her anaemia which was eventually confirmed to be autoimmune red aplasia.
Results:  Whilst there are some cases of stroke with severe anaemia, almost all of these relate to iron deficient anaemia and particularly in children. This makes our case unique in that this related to a pure red cell aplasia, which resulted in a hypovolaemic state with the patient hypotensive on presentation. Given this and the watershed distribution of infarcts low blood pressure is much more likely as the cause of stroke as opposed to a thrombotic cause. 
Conclusion: Whilst most cases reported tell of iron deficiency anaemia causing a prothrombotic state and formation of carotid thrombus this case is rather more unique. This case shows a stroke caused by hypovolaemia secondary to a acquired anaemia, which does not appear to have been described before. 

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