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30 June 2022 : Case report  Saudi Arabia

Extremes of Anemia: The Lowest Hemoglobin Values Probably Ever Reported in the Pediatric Literature Attributed to Iron Deficiency Anemia

Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Unexpected drug reaction , Clinical situation which can not be reproduced for ethical reasons

Khaled Yaseen Shalby1ABCDEFG*, Alzahra Y. Alradhi2ABCDE, Sinan Jamal Holdar1ABCDE, Abdullah S. Alghamdi1ABCDE, Saleh Abdulaziz Alduilej2ABC, Saad Albuainain1DG, Ahmed M. Al Zaghal1ABCDE, Nabeel A. Sadiq1ABCDE

DOI: 10.12659/AJCR.936252

Am J Case Rep 2022; 23:e936252

Abstract

BACKGROUND: Iron deficiency anemia is the most widespread, preventable, and treatable cause of anemia in children. Potential causes of iron deficiency anemia are prolonged breastfeeding with poor quality of introduced solid food and the use of whole cow milk instead of iron-rich formula. We describe 2 unusual cases of nutritional iron deficiency anemia with profound low level of hemoglobin around 1 g/dl, with similar diagnosis and different hospital course.

CASE REPORT: First case: A 20-month-old Saudi boy presented with symptoms of acute gastroenteritis. He was noted to be very pale, with extremely low hemoglobin value of 1.1 g/dl. His nutritional status mostly consists of breastfeeding, with poor iron-rich food. He was admitted to the pediatric intensive care unit with a complicated hospital course of reversible cardiomyopathy and gut involvement. Second case: A 26-month-old Saudi girl presented with complaints of severe pallor and fatigability for 2 months, with critical result of extreme low level of hemoglobin 1.2 g/dl. A detailed nutritional history revealed being exclusively on pasteurized cow’s milk with no solid food intake for 6 months.

CONCLUSIONS: Neglected cases of nutritional iron deficiency anemia may lead to profoundly low levels of hemoglobin. Possible manifestations include heart failure and gastrointestinal involvement in the form of leaky gut syndrome or exudative enteropathy. IV iron therapy was a very effective treatment in both patients. To our knowledge, probably no reported cases of severe iron deficiency anemia reaching this extremely low level of hemoglobin with multiple associated complications exist in the pediatric literature.

Keywords: Anemia, Iron deficiency anemia, Iron-Refractory Iron Deficiency Anemia, Nutritional Anemia

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923