JAMA Clinical Challenge
Patient With Anemia and Blue Sclerae
Javier Munoz, MD
Amr Hanbali, MD
A 60-year-old man with a history of multiple fractures after
minor trauma presents for evaluation of anemia with a hemoglobin
level of approximately 9 g/dL. Other medical problems include
chronic hypertension and worsening chronic kidney disease (CKD).
His family history is remarkable for short stature and dental
problems. Physical examination reveals a short male with blue
Figure). Iron levels are normal and ferritin is
elevated. A kidney biopsy performed for renal dysfunction
progressing more rapidly than expected reveals glomerulosclerosis
compatible with hypertensive nephropathy. A bone marrow biopsy is
negative for malignancy and shows elevated iron levels.
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Author Affiliations: Dr Munoz (
) and Dr Hanbali are affiliated with the Department of
Hematology/Oncology, Henry Ford Hospital, Detroit, Michigan.