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Anthony Bray MD
Anthony Bray MD, Family Practice Physician
Category: Pediatrics
Satisfied Customers: 10337
Experience:  14 years Family Practice experience including inpatient and outpatient pediatric care.
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My little boy is now 17 months. He was diagnosed as being

Customer Question

hi
My little boy is now 17 months. He was diagnosed as being anaemic about 7 months ago. He was put on an iron tonic (pure iron) 5ml a day for 3 months. He had blood tests every 6 weeks to check his ferratin, iron and haemoglobin but it took 3 months for his levels to return to normal. The doctor then said to put him on a maintenance dose of iron 3 times a week for a further 3 months and he would be fine. I took him to have his bloods rechecked after this 3 months of maintenance with the following results:
Haemoglobin was 12.4 (normal range is between 11-14.5)
Ferratin was 30 (normal range is betwwen 21.8-200)
Iron was 5 (normal range is betwwen 14-32)
So haemoglobin and ferratin are normal but Iron is well below normal . Doctor didnt know why and said i should see a consultant. Any opinions on why his iron is back to the low levels again? why would the ferratin and haemoglobin be normal and iron is so low. Why would this be?
should i see an haemotologist?
I am worried about my little boy
Submitted: 1 year ago.
Category: Pediatrics
Expert:  Anthony Bray MD replied 1 year ago.

Hello!

I think that this is probably as much a tribute to his pediatrician's thoroughness...

Young children have a very high iron requirement due to their growth. Iron deficiency is actually common in young children but I have not noted this to be frequently checked(not as routinely as it probably should) Thus I think many such cases are missed.. so at his age it is probably most likely more associated with the high requirement of his growth more than other factors that may be associated with his finding now of the iron deficiency...

Now he may need to have tested stool samples to check to make sure that he is not losing blood via the stool. That is in general the most common reason for low iron and iron deficiency anemia.

It is noted that he is not currently anemic but still has the iron deficiency..

It may help to give the iron supplement along with some vitamin C or orange juice. Iron needs acidity to be absorbed. It could be that if his stomach has low acidity then this could reduce his iron absorption...

The low iron is going to be due to some unusual loss (as in some source of bleeding into the stool for example) or low absorption such as may occur if he had low stomach acidity..(This is sometimes an occurrence if he should take medicine for reflux such as Zantac for example...

I hope that this information is helpful for you. let me know if you have further questions. I will be happy to get back with you! If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. Thank You and Best Regards,

Anthony Bray MD

Customer: replied 1 year ago.

So what are you suggesting. Should i just accept these results or go to a haematogist for further testing . My gp is unsure what to do . What do you think. Are you saying it is normal to have a low iron level but a normal ferratin level? should i be concerned about this

Expert:  Anthony Bray MD replied 1 year ago.

Hello again,

I think that your son should see the hematologist and continue with further iron supplementation. I would advise the iron be given along with orange juice.The hematologist may REVIEW his current results to date. He may not require that much further testing at this time. I think follow up down the road is more the case of what would be advised...

I suspect that HE DOES NOT HAVE a hematologic problem however...

I understand that his pediatrician is referring him for a second look and opinion because he has an unexpected result on his hands that he is unsure of. That is why he wants the hematologist to take a look as well. The hematologist is expert in blood disorders but also iron deficiency problems as well.

I think the results are not dramatic as he is not anemic and his ferritin levels are good but I see that he still had the low serum iron level... young children often do have low iron at this age related to high needs associated with their rapid growth..so I think that he does not have any disease or major problem here. I think the follow up with the specialist is a precautionary measure... I encourage you TO NOT TAKE THIS REFERRAL AS ANY OMINOUS SIGN!! I do NOT think that this is the case at all.. I think that the pediatrician here is simply being careful and expected a better outcome from the initial iron supplement. The pediatrician is scratching his head as to why it did not respond better..

I hope that this is helpful and makes sense. Let me know if you have further questions or concerns. Best Regards,

Anthony Bray MD

Expert:  Anthony Bray MD replied 1 year ago.

Let me know if I may be of further help! Best Regards!

Anthony Bray MD

Customer: replied 1 year ago.

I also had him checked for lactose intolerant and coeliac and both of these were negative. I understand what you are saying about the growth as he is a particularly big toddler . he is only 17 months and weighs 13 kg(29lbs) , height of 86cm and wearing clothes for a 2 year old. He does get alot of colds though and wonder if it is because his immune system is down because of the iron. But if the ferratin is normal would his immune system be down. I dont really understand the difference between the iron level and the ferratin level

Expert:  Anthony Bray MD replied 1 year ago.

Hello again,

Yes it can be a bit confusing. They are two measures that are very similar actually and they tend to be inter-related. Ferritin is an iron carrying protein. If he was too low on either then that could be a sign of iron deficiency. I don't expect that he has any problem with immune deficiency > No to that...

Expert:  Anthony Bray MD replied 1 year ago.

I hope that this is helpful. Let me know if you have further concerns!

Take Care!

Anthony Bray MD