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Peliosis hepatis (PH) is a rare condition showing presence of multiple blood‑filled cystic cavities in the liver. It does not have any gender predilection, and is suspected to be idiopathic. However, in patients with predisposing diseases, its prevalence can range from 0.2 to 22%. The association between PH and anemia has not been completely established. PH has been reported in a patients with hematologic disease, and also in patient with spherocytic haemolytic anemia. It is also suggested that acute sequestration of blood can happen in these sinusoidal cavities, which can lead to development of anemia and thrombocytopenia. We present a case of 40-year female who presented with abdominal pain and recurrent iron deficiency anemia. On examination, she was severely pale, and had moderate hepatosplenomegaly. Ultrasonography showed hepatomegaly and splenomegaly, and her blood investigations revealed severe iron deficiency with bone marrow showing hypercellular marrow with depleted iron stores. Upper gastrointestinal endoscopy was normal. Liver biopsy showed changes suggestive of peliosis hepatis. She was treated with iron and multiple blood transfusions and is in good health 6 months post presentation. Also, the association between anemia and PH has not been established.
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