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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29518
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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A 4.5year old boy with symptoms of fatigue, grumpy,sleepy,whiney,itchy

Resolved Question:

A 4.5year old boy with symptoms of fatigue, grumpy,sleepy,whiney,itchy and not growing.
Test done reveal Hb10, iron 2.0L and %IS 4L
Has been given 100mgs iron since June and the test done 2nd October
Mother is desperate and lives in Asia and cannot get any answers
Can you help?
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.
Greetings.

The symptoms of fatigue, sleepy, itchy, failure to thrive (not growing) with low hemoglobin, low iron is indicative of anemia and can be due to following possibilites;

1) parasitic disorder,
2) tuberculosis
3) other chronic infections.
4) low thyroid

Normal serum iron levels for toddlers range between 50 mcg/dL and 120 mcg/dL. For toddlers, hemoglobin levels, which represent the iron-carrying capacity of blood, should range between 9.5 g/dL to 14.0 g/dL. Ferritin is a blood test which evaluates for the total iron available in the body. Serum ferritin is the most useful test for diagnosing iron-deficiency anemia. Low serum ferritin (less than 12 ng/mL) is highly specific for iron-deficiency anemia. Please read this resource;

 

http://www.emedicinehealth.com/anemia/page5_em.htm

 

The other most common causes to look for his manifestation and investigations are;

 

1) iron deficiency (with or without blood loss),

2) chronic disease/inflammation

3) chronic kidney disease

4) deficiencies of folate or vitamin B-12,

5) diseases of the bone marrow

6) hypothyroidism, hypersplenism, and hemolytic anemia

 

So investigations entail;

 

1) Complete blood count (CBC)

2) Peripheral blood film

3) Vitamin B-12

4) Folate

5) Reticulocyte count

6) LDH

7) Thyroid-stimulating hormone

8) Serum creatinine and estimated glomerular filtration rate

9) Serum ferritin

10) Serum iron

11) Total iron-binding capacity

12) PPD test / MT test

13) Chest x-ray

14) Stool test for parasites

 

So these investigations need to be done for the exact assessment and long term management.

 

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

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Customer: replied 1 year ago.

as you can appreciate I must email his mother with your reply and get her reaction


Thank you for your help. Hopefully this will be a help for her


Thank you


Polly

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are very welcome.

Sure Polly. Please let me know her follow up queries. I would be glad to answer them.

It is privilege assisting you.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29518
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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