Severe anaemia in an 11-month-old girl

Abstract

An 11-month-old girl came to Chikwawa District Hospital Malawi in March 2003 with a 7-day history of fever. She had been treated at a rural health center with sulfadoxine-pyrimethamine for suspected malaria without improvement. The child was pale here weight was 7.6 kg (90% weight for height) temperature 38.6°C pulse rate 160 per min and respiratory rate 28 per min. There were no signs of jaundice or bleeding. Her chest was clear liver 3 cm enlarged and her spleen was not palpable. Initial laboratory tests showed haemoglobin (Hb) of 35 g/L and negative malaria microscopy. After obtaining consent from her parents a bone-marrow aspirate was taken as part of a severe anaemia protocol. Blood transfusion was commenced and broad-spectrum antibiotics started. At discharge after two days she was afebrile with Hb of 81 g/L. Additional laboratory results showed platelets 172X10(12)/L; mean cell volume 92.5 fl reticulocytes 1(2% leucocytes 22.1X10(9)/L (neutrophils 36% lymphocytes 47%); folic acid 14.8 ng/mL (normal 3-17) and vitamin B(12) 131.1 pg/mL (200-950); HIV serology and blood culture were negative. Bone-marrow microscopy showed megaloblastic changes and a minimal amount of stainable iron (2% sideroblast no iron particles in macrophages). Flow cytometry showed a high expression of CD71 (transferrin receptor) on the red progenitor cells in accordance with an increased iron need. Because of constipation she could not provide a stool sample at admission but one was collected 4 days after discharge. (excerpt)