Abstract
BackgroundAnemia is a common presentation in children but the differential diagnosis of iron deficiency and β-thalassemia remains a diagnostic challenge. Red blood cell indices have been shown to perform weakly in such scenarios. One potential cause is breastfeeding, but the evidence for unusually prolonged exclusive breastfeeding as a cause of iron deficiency anemia in older (>2 years) toddlers is sparse and the association of breastfeeding with iron deficiency in this age group of older toddlers is not unequivocally established. In this case we describe an unusual cause of nutritional iron deficiency anemia in the age group of 2–3 years.Case presentationWe describe a two-and-a-half-year-old Turkish boy who presented to our outpatient clinic with recurrent diarrhea and anemia. The patient was febrile (99.1°F) with pale skin and signs of mild dehydration. A reduced nutritional status with a weight of 11.5 kg between the 3rd and 10th percentile was noted. Nutritional evaluation revealed that the boy was still exclusively breastfed with more than 6 times breastfeedings per day. Iron supplementation ameliorated the anemia and reduced hypochromic red blood cells.ConclusionThe case demonstrates that unusually prolonged (longer than two years) exclusive breastfeeding is a potential cause of iron deficiency anemia in older toddlers. We discuss a simple combination of laboratory tests with ferritin and red cell distribution width that together with a nutritional evaluation provide a quick diagnosis and show that even at such an advanced stage of nutritional iron deficiency oral iron supplementation is an effective treatment.
Highlights
Anemia is a common presentation in children but the differential diagnosis of iron deficiency and β-thalassemia remains a diagnostic challenge
The case demonstrates that unusually prolonged exclusive breastfeeding is a potential cause of iron deficiency anemia in older toddlers
We discuss a simple combination of laboratory tests with ferritin and red cell distribution width that together with a nutritional evaluation provide a quick diagnosis and show that even at such an advanced stage of nutritional iron deficiency oral iron supplementation is an effective treatment
Summary
The case demonstrates that unusually prolonged EBF even in older toddlers (>2 years) is a potential cause of IDA. Breastfeeding dependent IDA has recently largely been considered and associated with EBF at 6 or 12 months. The diagnosis of iron deficiency anemia secondary to unusually prolonged breastfeeding has to be taken into consideration in toddlers, in particular considering the increasingly heterogeneous cultural background of patients. Consent Written informed consent was obtained from the patient’s legal guardian(s) for publication of this case report and any accompanying images. Authors’ contributions BI and FB reviewed the data and wrote the manuscript. Author details 1Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany. Author details 1Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany. 2Department of Pediatrics, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany. 3Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
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