Grand Rounds

Refractory Iron Deficiency Anemia


Minhajuddin Ahmed Shweta Goyal Shweta Anand
Department of Pediatrics, Chirayu Medical College & Hospital, Bhopal, Madhya Pradesh

Address for Correspondence: Dr. Minhajuddin Ahmed, Department of Pediatrics, Chirayu Medical College & Hospital, Bhopal, Madhya Pradesh. Email: minzahmad@yahoo.co.in


Clinical Problem:
A 10-year-old male child came to our out-patient department (OPD) for evaluation of refractory anemia. He had received adequate dietary and oral iron supplementation but still required multiple blood transfusions. He had no anorexia, nausea, vomiting, diarrhea, abdominal cramps or bleeding from any site. There was no family history of blood transfusions. Laboratory investigations showed hemoglobin of 6.4 gm/dl, total leucocyte count 7600 cells/cumm, erythrocyte sedimentation rate (ESR) 18 mm/hr at end of 1 hour, packed cell volume 22%, mean corpuscular volume 54.1fL, mean corpuscular hemoglobin concentration (MCHC) 25.4gm/dL, Red blood cell distribution width (RDW) 17.2%, reticulocyte count 1.13%, serum ferritin 2.6ng/dL, serum iron 15ug/dL and Total Iron Binding Capacity (TIBC) 570 mcg/dL suggestive of iron deficiency anemia (IDA). Peripheral film showed microcytic hypochromic anemia. Hemoglobin electrophoresis and thyroid function tests were normal. Routine stool examination was normal and occult blood was negative.

What could be the cause of the iron deficiency anemia?


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