Review Question - QID 104790

Iron deficiency is the most common nutritional deficiency in children and should be suspected in children with a very high intake of cow's milk.

While the mechanism is not directly understood, it is thought that the high concentrations of calcium and casein in cows milk inhibits non-heme iron absorption. Iron deficiency leads to a microcytic anemia and is the most common anemia worldwide. Causes include menstruation, pregnancy, lactation, chronic blood loss, dietary deficiency (especially in children). In the elderly, iron deficiency anemia is colon cancer until proven otherwise. Serological evaluation will reveal an elevated total iron binding capacity (TIBC), low serum iron and serum ferritin.

Short and Domagalski discuss iron deficiency which they state is diagnosed by low iron stores and a hemoglobin level two standard deviations below normal. Screening for iron deficiency should be undertaken in pregnant women and children at one year of age (as in this case). Typically, the best next step when iron deficiency is suspected is a trial of supplemental iron followed by further analysis if the patient does not respond.

Paoletti et al. discuss chronic, severe iron-deficiency anemia (IDA) in early childhood. They state that IDA in young children increases the risk of irreversible disruptions in cognitive, affective, and motor development. IDA in infants has decreased in recent years because of dietary changes, particularly the increase in iron-fortified formula and delaying cow's milk. In a study of children with IDA, daily cow's milk consumption surpassed 24 ounces for 47 of 48 children and 11 consumed more than 64 ounces per day.

Illustration A displays a peripheral blood smear of iron deficiency anemia with hypochromic microcytic red blood cells.

Incorrect Answers:
Answers 1, 3-5: These factors would be less likely to result in an iron deficiency anemia in this patient