The study was conducted in 2 boys aged 17 and 16 and a 12-year-old girl sent to the clinic for further diagnosis of elevated levels of hemoglobin, which were discovered during laboratory assays performed in an outpatient setting, at the request of the parents. The general condition of all the children was good and they had no existing complaints. On physical examination, no deviations from the norm were found in the 16-year-old boy and 12-year-old girl. The 17-year-old, however,

was found to be obese with a BMI of 32. A few years earlier due to this condition (abnormal weight), this patient had undergone endocrinological investigation. Although abnormal eating habits were identified as the major cause, the patient did not follow dietary recommendations given. Laboratory assays performed on him at the time revealed a hemoglobin concentration on the upper limit of the norm. Furthermore, click here additional previously performed assays also revealed a hemoglobin concentration

that was also on the upper limit of the norm or that periodically exceeded it. In the analysis of past medical history and concomitant diseases of the other 2 children there were no serious ailments noted and they adhered to good dietary practises. All the children were physically active. Imaging studies – an abdominal ultrasound and echocardiography – were performed on all 3 children. The abdominal ultrasound of the 17-year-old patient revealed a longitudinally enlarged spleen whereas the echocardiography performed on the girl revealed residual mitral Ruxolitinib regurgitation, which was hemodynamically insignificant. The remainder of the imaging studies revealed no deviations from the norm. On further investigation, a positive family history was noted for the 17-year-old boy and 12-year-old girl. It was noted that the oldest patients’ father had died of heart failure at the age of 42 years, had had a history of poorly managed hypertension, obesity and nicotinisim. Ribonuclease T1 Laboratory assays of the girl’s father

preformed beforehand, revealed elevated levels of serum ferritin and he was awaiting a hematological consultation. All the parents’ hemoglobin levels were normal. None of the children had ever been on any kind of medication, including iron preparations or vitamins fortified with iron. All the patients underwent laboratory assays which included, a full blood count with reticulocytosis and microscopic evaluation, alanine concentration, aspartate and alanine transaminases, bilirubin, creatinine, total protein, CRP, coagulation profile, HBsAg and anti-HCV antibodies, erythropoietin levels, urinalysis, and capillary blood gas. Iron metabolism was also assessed by measuring iron concentration, ferritin and transferrin saturation. In addition, bone marrow biopsy was carried out on the oldest boy and girl. All 3 patients had hematocrit levels that exceeded the reference value for their age.