Treatment of iron deficiency anemia and associated protein-losing enteropathy in children

Purpose: The aims of this study were to evaluate the response of oral iron treatment in children with iron deficiency anemia (IDA) fed whole cow's mil k (WCM) or soy formula; to compare the incidence of fecal blood loss in inf ants fed WCM and soy formula; and to evaluate the incidence and relation of protein-losing enteropathy (PLE) and IDA by testing serum albumin, fecal b lood loss, and fecal alpha(1)-antitrypsin (alpha(1)AT). Methods: Twenty-four children with nutritional IDA were randomly assigned t o receive either 16 oz WCM or soy formula daily. Both groups were treated w ith daily therapeutic oral iron during 12 weeks. Stool specimens for hemogl obin losses were collected at weeks 0, 3, 6, and 12. Levels of serum albumi n and fecal alpha(1)AT were tested at diagnosis and when LDA was corrected. Results: Anemia was corrected in 21 of the 24 children by week 6 or 12. Med ian fecal hemoglobin losses were not increased in either group at diagnosis or during treatment. Seven of 24 children had PLE at diagnosis with elevat ed fecal alpha(1)AT levels of 72 to 381 mg/dL that returned to normal after correction of IDA. Their initial fecal alpha(1)AT levels averaged 170 mg/d L at diagnosis and 21 mg/dL after the IDA was corrected. Excessive WCM inta ke of 30 oz/day or more was present in 63% of the infants. Conclusions: Treatment of nutritional IDA with oral iron was just as effect ive with a limited quantity of either WCM or soy formula. Fecal hemoglobin losses were uncommon and did not differ in children at diagnosis or during treatment of IDA. PLE associated with IDA resolves when the IDA is correcte d, but differences between children fed WCM or soy formula could not be det ected.