This case study describes a 15-year-old female patient who presented with a mass in her left breast and symptoms of anemia. Laboratory tests confirmed she had iron deficiency anemia. An ultrasound revealed a 5x3cm fibroadenoma in her breast. She received a blood transfusion to improve her hemoglobin levels before undergoing surgery to remove the fibroadenoma. Her treatment included iron supplements and antibiotics to address the anemia and a concurrent upper respiratory infection.

1. Case study on Anemia and
Fibroadenoma:
J. Anisha Ebens
Pharm D VI yr

2. Introduction to anemia:
Iron deficiency anemia is the most common type of anemia, and it occurs when your
body doesn’t have enough of the mineral iron. When there isn’t enough iron in your
blood stream, the rest of your body can’t get the amount of oxygen it needs.
Causes: Loss of iron - heavy menstruation or pregnancy, poor diet or intestinal
diseases affecting absorbtion of iron.
Symptoms (moderate to severe): General fatigue, Weakness, pale skin, shortness of
breath, Dizziness, strange cravings to eat items that aren’t food, such as dirt, ice, or
clay, a tingling or crawling feeling in the legs, tongue swelling or soreness, cold
hands and feet, fast or irregular heartbeat, brittle nails, headaches.
Diagnosis: RBCs, WBCs, Hemoglobin, Hematocrit, Platelets.
Treatment: Iron tablets can help restore iron levels in your body, Diet, In the most
severe cases, a blood transfusion can replace iron and blood loss quickly.

3. Introduction to fibroadenoma:
Fibroadenomas of the breast are benign tumors characterized by an
admixture of stromal and epithelial tissue. Since both fibroadenomas and
breast cancer can appear as similar lumps, it is currently recommended to
perform ultrasound analyses and possibly tissue sampling with subsequent
histopathologic analysis in order to perform diagnosis. Unlike typical
lumps from breast cancer, fibroadenomas are easy to move, with clearly
defined edges.
Signs and symptoms: lump of mass which is usually movable.
Cause: hormone related.
Diagnosis: It is diagnosed by FNA, ultra sound, mammogram.
Treatment: Surgery or hormone balance. Mostly it will not recur, but in
some cases it may recur again.

4. Ms. S 15 yr old female patient was admitted in the hospital
(16.08.2018),
C/O: Mass in left breast x 1yr, no pain, no discharge, no
redness – outpatient.
Increase in size gradually.
Itching in perineural region.
19/8- Cough with expectorency, running nose, throat pain,
difficulty in breathing, nausea.
H/O: Swelling in Lt breast, gradual onset, progressive in
nature, attained present size, itching in nipple.
No H/O of discharge in nipple, wt. loss, fever.
Case study:

5. Personal history: menstrual H/O- irregular periods for
the past 6 months, 2 months once- 3 to 4 days,
increased passage of clots.
O/E: Pallor, consious, oriented.
BP: 110/80, Pulse: 80/min.
Lab investigations: Blood group B(+)ve
Parameter Report Value Normal value
Hb 8.4 on 16.8
5.4- As out patient
12-16g/dl
TLC 8.1 4500 – 11000 cells/mm³
Platelets 5.34 1.5 – 3.5 lakhs/mm³
PCV 20.8 36.0-46.0%
Urea 9 8-25mg/dl
Creatinine 0.37 0.6-1.5mg/dl

6. Other investigation:
•FNA left breast- benign breast disease,
•Serology- negative
•Left breast- firm, nodule in upper medial quadrent-
5x3cm, non tender.
Impression: 5x3cm nodule in breast, microcytic
hypochromic anaemia.
Diagnosis: Iron deficiency anaemia, Fibroadenoma,
20/8- URI.
Plan: To improve the Hb levels and then do surgery.

7. Started with blood transfusion on 17.08.2018.
After 1 unit of blood transfusion Hb- 10.5 g/dl

8. Treatment chart:
As out patient: T. LIVOGEN -BD x 15 days
T. PAN -BD x 15 days
Drugs Dose R.O.A. Freq. No. Of Days
17 18 19 20 21 22
T. ALBENDAZOLE 400mg P/O Stat   
T. LIVOGEN 1 tab P/O 0-1-0   
T. LIMCEE 500mg P/O 0-1-0 
T. AZITHROMYCIN 500mg P/O OD  
SYP. ASCORIL 7.5 ml P/O BD  
T. AUGUMENTIN 625mg P/O 1-0-1   
T. CETIRIZINE 5mg P/O 0-0-1   
CAP. MUCOLITE SR 75mg P/O 1-0-0   
SYP. CHERICOF 10ml P/O SOS   

9. Pre operative treatment (22.08.2018):
Inj. TT
Inj. XYLO (test dose)
Inj. TAXIM
Operation on 23.08.18.
Discharge summery:
• Adviced to continue T.AUGUMENTIN, CAP. MUCOLITE
SR, SYP CHERICOFF.
• Adviced to take more iron rich foods.
Pharmacist intervention: There is no drug interactions.

10. SOAP notes:
Subjective - A 15 yr old female patient was admitted in
the hospital on 16.08.2016.
Objective - Mass in left breast x 1yr, no pain, no
discharge, no redness. Gradual increase in
size. No H/O wt. loss, discharge from nipple.
Assessment -Impression: 5x3cm nodule in breast,
microcytic hypochromic anaemia. Diagnosis:
Iron deficiency anaemia, Fibroadenoma,
20/8- URI.
Plan - T. ALBENDAZOLE, T. LIVOGEN, T.
LIMCEE, T. AZHITHROMYCIN, SYP.
ASCORIL, T. AUGUMENTIN, T.
CETIRIZINE, CAP. MUCOLITE SR, SYP
CHERICOFF.