8-month-old male infant is brought in for routine checkup by his mother. The child is pale, but other than that, looks healthy, with growth parameters within the expected range. The mother informed that boy was breast fed for three months, followed by cow's milk substitute. For the last two months, she started giving him fruits and vegetables; however, she still hasn't introduced eggs and milk into the boy's diet. Complete blood count (CBC) shows hemoglobin (Hgb) level to be 9g/dL, mean corpuscular volume (MCV) of 65fL, increased total iron binding capacity (TIBC) and low serum iron. Neither mother nor father have a positive family history for any blood disorder. What is the best treatment?
Answer: d) It can be treated with proper diet and iron supplementation Microcytic anemia caused by iron deficiency can be treated with proper diet and iron supplementation. Parents should be advised not to give eggs and meat at the same time as dairybecause of the intake interference. Multivitamins would not be helpful in this case because iron is deficient, not vitamins. Proper diet is important, but since the hemoglobin is low, iron supplementation is supposed to be given. Iron supplementation alone would be helpful for short term, but anemia would appear again after therapy if proper diet is not followedIRON DEFICIENCY ANEMIA* Most common type of anemia worldwide* Chronic blood loss is the most common cause of iron deficiencyIron absorption increased byIron absorption reduced by* Heme iron (10-20% absorbed)* Ferrous form (Fe2+)* Animal foods* Acid pH* Vitamin C* Increased erythropoiesis* Pregnancy* Hypoxia* Amino acids, Sugar* Iron deficiency* Non heme iron (1-5% absorbed)* Plant foods* Ferric form (Fe 3+)* Alkali pH* Iron overload* Achlorhydria* Phytates, tannates in tea* Decreased erythropoiesis* Inflammatory disorders On an average, only 10% to 15% of ingested iron is absorbed The major iron transporter from the diet across the intestinal lumen - ferroportin Iron absorbed from the diet or released from stores circulates in the plasma bound to transferrin, the iron transport proteinStages of Iron deficiencyNegative iron balanceIron deficient erythropoiesisIron deficiency anemia* Demands exceed the body's ability to absorb iron from diet* Serum ferritin decrease* Stainable iron on bone marrow aspirations decrease* Serum iron, TIBC, red cell protoporphyrin levels, RBC indices, morphology - normal* Marrow iron stores depleted - Serum iron decreases - TIBC & Red cell protoporphyrin levels increases - Transferrin saturation decreases - first appearance of microcytic cells, hypochromic reticulocytes* Decreased Hb* Decreased hematocrit* Transferrin saturation: 10 -15%* Hb<7g/dL: target cells and poikilocytes* Within the erythroid cell, iron in excess of the amount needed for hemoglobin synthesis binds to a storage protein, apoferritin, forming ferritin* Serum ferritin level is the most useful test to diagnose iron deficiency* Serum ferritin level is the most convenient laboratory test to estimate iron stores* Average Se ferritin levels: Adult males -100 mg/L; adult females - 30 mg/L* Marrow iron stores are absent when the serum ferritin level is <15 mg/L.* Transferrin receptor protein (TRP) - increased in absolute iron deficiency* MCCs of increased red cell protoporphyrin levels - absolute or relative iron deficiency and lead poisoning.Treatment* 300mg elemental iron daily* Reticulocyte count begins to rise within 4-7 days after initiation of therapy* Failure of response to iron therapy is usually due to noncompliance* Parenteral Iron indications - intolerance to oral iron, refractoriness to oral iron, gastrointestinal disease, and continued blood loss* For parenteral iron therapy, Amount of iron needed= Body weight (kg) x 2.3 x (15 - patient's Hb ) + 500 or 1000 mg
It can be treated with multivitamins.
It can be treated with proper diet only.
It can be treated with iron supplementation only.
It can be treated with proper diet and iron supplementation
Blood