Diagnostic Dilemma - Pediatric Oncall
Author: Vidya Prakash Fadnis
Recently I came across 2 babies: one 2 yrs old and other 3yrs old with sever pallor. Both parents gave history of pica, history of prolong breast feeding with inadequate and improper weaning food. Parents of both children complained of very inadequate oral intake. On exam and on investigations, both the children were suffering from severe nutritional iron deficiency anemia. Table 1 gives their biochemical profile.
Serum folic acid and vitamin B12 were normal. As we know in case of iron def anemia early changes that we get are depletion of iron stores i.e serum ferritin is reduced. Next is reduced s.iron and then increased TIBC. Microcytic hypochromic changes occur after these changes. In above mentioned patients peripheral smear was showing microcytic hypochromic changes in RBCS but still s.ferritin, s.iron, TIBC were normal.
Answers of this discussion
Author :- Ayman Al Abdullah on 22 February 2014.
Answer :- thallasemia minor or major

Author :- Iurian Sorsab on 22 February 2014.
Answer :- Shahidi-Diamond syndrome

Author :- R Rajagopal on 22 February 2014.
Answer :- Congenital atransferrinemia is a possibility, autosomal recessive inheritance. Must also look signs of iron overload .would also want to check for thalassemia on hemoglobin electrophoresis or genetic testing.

Author :- K. Brindha on 22 February 2014.
Answer :- its better to rule out thalassemia group other than thalassemia major in these kids.because the concominant reduction in iron , ferritin in IDA can be countered by thalssemia.Can give a course of iron and if no further improvement ,can proceed to HB electrophoresis

Author :- sontenam chittibabu on 23 February 2014.
Answer :- R, 0 thalassemia

Author :- martin westinner on 23 February 2014.
Answer :- The degree of anemia in both cases is very severe, i.e. life threatening.. 1.Any acute inflammatory condition will produce an hepcidin-mediated worsening anemia in a child who already has baseline iron-deficiency anemia. Ferritin is an acute phase reactant and isn`t low because there is an inflammatory condition. 2 this patient had pica I think he could have lead poisoning

Author :- benketira Abdelkader on 23 February 2014.
Answer :- coeliac disease

Author :- Mustafa Aydin on 23 February 2014.
Answer :- due to pica

Author :- kashan arshad on 23 February 2014.
Answer :- lead poisoning

Author :- mohamed mansor on 24 February 2014.
Answer :- iron deficiency anemia

1 2 
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.