DIAGNOSIS OF IRON-DEFICIENCY ANEMIA

Background. Malabsorption of oraliron is rare, and more frequently sus pected than proved. It could be due to prolonged iron deficiency. Case reports. Case no 1 : A boy was admitted at the age of 5 months for re current bronchitis. His hemoglobin was 8.2 g/dl, mean corpuscular volu me (MCV) 60 mu3, mean corpuscular hemoglobin (MCH) 15 ng and mean corp uscular hemoglobin concentration (MCHC) 25 gHb/dl. The serum iron was 1 mug/dl, iron binding capacity (IBC) was 284 mug/dl and ferritin was 14.9 ng/ml. Dietary iron was inadequate. The patient was given ferrous sulfate but iron deficiency persisted at the ages of 11 months and 3 years, probably due to poor compliance. Similar hematologic data (Hb : 6.4 g/dl, MCV 55 mug/m3 MCH 13.9 ng, MCHC 24 gHb/dl) were found at th e age of 9 years. The patient was then given ferrous sulfate orally as test but the serum iron levels were unchanged during the 4 hours foll owing ingestion. A parenteral iron preparation (iron-dextran, 500 mg) improved the hematologic data. 6 months later, a new oral test with fe rrous sulfate improved the serum iron level. Case no 2 : A boy with co mplex congenital cardiopathy was operated on in the neonatal period an d given oral iron at the age of 9 months because of anemia with microc ytosis and hypochromia. This anemia was still present at 17 months and was associated with normal or high serum ferritin. Electrophoresis of hemoglobin was normal At the age of 4 yr 5 mo, Hb was 9.7 g/dl, MCV 6 2.8 mug/m3, MCH 18.4 ng, iron 16 mug/dl and ferritin 94. 1 ng/ml. An o ral test with ferrous sulfate failed to increase the serum iron. The p atient was then given parenteral iron-dextran without benefit, and a s econd oral test remained ineffective. After a second course of parente ral iron-dextran, Hb was 11.5 g/dl, MCV 74. 1 mug/m3 MCH 23.7 ng while the serum iron remained low (23 mug/dl) and ferritin increased to 587 ng/ml. A third oral test with ferrous sulfate was still ineffective, as was a test using 4 mg/kg iron. Conclusion. The first patient suffer ed from iron malabsorption, presumably due to iron deficiency. The sec ond patient could have abnormal metabolism and/or abnormal ferritin.