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A 48-year-old native highlander of the Leh Ladakh region (approximate height 12 000ft) was diagnosed with severe koilonychia after visiting a medical camp ( figures 1 - 4 ).
On examination, his built was normal, there was no pallor and no other signs of nutritional deficiency. Abdominal, respiratory, neurological and cardiovascular examinations were normal. The patient's haemoglobin was 16.1 g/dL. All other haematological and biochemical parameters were normal. Peripheral blood smear revealed a normal picture. Iron studies revealed serum iron of 105 (65-175) [micro]g/dL, the total iron binding capacity...