This child's anemia is caused by a chronic disease, most likely celiac disease. The next steps in management would be to confirm the diagnosis which would include a referral to Gastroenterology for endoscopy.
A 23 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 4 months. Diet history: child eats a wide variety of foods from all four food groups and consumes 13 ounces of milk and 5 ounces of juice per day. Immunizations are up to date. The child stays at home with a nanny.
On exam the child appears pale. Vital signs are normal. The child is currently at 10th percentile for weight and had been on the 50th percentile for weight over the last 20 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
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
Dr. Susan Bannister
Susan.Bannister@ahs.ca
Dr. Angela Punnett
angela.punnett@sickkids.ca
Dr. Hosanna Au
Reviewer