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,
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;
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
5) Reticulocyte count
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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