We encountered two patients who presented with
hypochromic-microcytic anemia and were refractory to
iron therapy. The symptoms were suggestive of
anemia of
chronic disease (ACD); however, there was no evidence of any such disease, either inflammatory or malignant. These patients were reminiscent of patients originally described as having primary defective
iron reutilization. The hematologic picture consisted of
hypochromic-microcytic anemia, low serum
iron, low to normal
iron binding capacity, high serum
ferritin, and increased bone marrow
iron in the absence of ringed sideroblasts. These patients had symptomatic
anemia and received
danazol (200 mg orally) three times per day to which they responded very well with an increase of approximately 3 g in the
hemoglobin concentration over 1 year and amelioration of their symptoms.
Danazol was well tolerated and did not cause any virilizing side effects. Doses were lowered in maintenance after 1 year to 200 mg once per week, and responses were sustained up to 36 months of follow-up duration. In the differential diagnosis of
hypochromic-microcytic anemia, especially in postmenopausal women, one has to consider this type of treatable
anemia when more common types such as
iron deficiency, chronic
inflammation,
malignancy,
sideroblastic anemia, or
thalassemia have been ruled out.