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A 12 month old child presents to your clinic for follow up of lab results (available below).

The child was seen last week for a well child visit. On history, you learned the child has intermittent abdominal pain, and child has a history of diarrhea for the past 2 months. Diet history: child eats a wide variety of foods from all four food groups and consumes 19 ounces of milk and 7 ounces of juice per day. Immunizations are 6 months behind schedule. The child stays at home with the father.

On exam the child appears pale. Vital signs are normal. The child is currently at 75th percentile for weight and had been on the 90th percentile for weight over the last 9 months.

Lab Results:

HGB: low

WBC: normal

PLT: normal

Reticulocyte Count: low

MCV: low

Serum Ferritin: low

TIBC: high

Iron Saturation: low

Plasma Iron: low

DAT: negative

Partially Correct

This child has fallen off his or her growth curve. This indicates an underlying disease process. The etiology of this child's anemia is most likely celiac disease or

inflammatory bowel disease.

References:

Zella GC & Isreal EJ. Chronic Diarrhea in Children. Pediatrics in Review 2012; 33: 207-218.

Overview on chronic diarrhea. Comprehensive differential diagnosis.

Hyams JS. Inflammatory Bowel Disease. Pediatrics in Review Vol. 26 No. 9 September 1, 2005, pp. 314–320.

An overview of IBD with a focus on differential diagnosis, presenting features as well as an overview of medications for IBD.

Iron Deficiency and Other Types of Anemia in Infants and Children. Am Fam Physician. 2016 Feb 15; 93(4):270-278.

http://www.aafp.org/afp/2016/0215/p270.html

Key recommendations for practice with flow diagrams capturing diagnosis based on age and MCV.

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Authors

Mike Paget

mkpaget@ucalgary.ca

Manager - Academic Technologies - Cumming School of Medicine

Dr. Susan Bannister

Susan.Bannister@ahs.ca

Dr. Angela Punnett

angela.punnett@sickkids.ca

What is the most likely diagnosis?

Streak:

Authors

Mike Paget

Dr. Susan Bannister

Dr. Angela Punnett

Dr. Hosanna Au