CASE OFTHE WEEK – “A 3 years old Indian girl was suffering from severe anaemia and Hemoglobin count at 1.7 gm/dl.” by Dr. Mohammad Aldisi, Consultant Paediatrician & Head of Department, NMC Royal Hospital Sharjah.

A 3 year old Indian girl was referred to the tertiary care PICU Department from a prominent hospital in Dubai. The baby was suffering from severe anemia and the Hemoglobin was noted at 1.7 gm/dL. The baby was admitted to the Pediatric ward as her vital signs were stable and exhibited no signs of heart failure. She was administered blood transfusion of 10 ml/kg packed RBCs from the referring hospital.

It was noted that the baby had poor nutritional history. She was taking fresh cow’s milk since birth and her food intake later was exclusively plain rice. At the age of one year, her Hemoglobin level was 5 gm/dL. The baby received blood transfusion followed by iron drops but she took it only for short time. There was poor follow up with the pediatrician either. During a routine check-up for cold and reduced physical activity the doctor requested some blood work due to severe pallor.

The blood results suggested severe iron deficiency anemia with severe microcytic and hypochromic RBCs. MCV 48, MCHC 24, MCH 11, RDW 21.6, Ferritin 0.5, Serum Iron after the Blood Transfusion 2.1, Retic 0.42.

After the 1st blood transfusion, the Hemoglobin count increased to 5.3 gm/dL. Considering the history of poor compliance with medicine and follow up, a 2nd blood transfusion was administered the following day. The patient was discharged after the Hemoglobin reached to 8.5 gm/dL. The parents of the patient received proper education about the negative impacts of anemia, on the physical & mental development of the child. They were also advised about the importance of optimal nutrition and proper medicine to avoid similar situations in the future and the need of regular follow up in the pediatric clinic.