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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35801
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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A 4.5year old boy with symptoms of fatigue,

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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?

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;

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 4 years 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


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.
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