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Suggest treatment for iron deficiency in a child

Answered by
Dr.
Dr. Hardik Sanghvi

Hematologist

Practicing since :2008

Answered : 7039 Questions

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Posted on Thu, 22 Sep 2016 in Blood Disorders
Question: Hello,
I am battling iron deficiency with my 8 year old daughter. We have been giving her iron supplements but her iron continues to drop. The iron is low and the ferritin is low the other numbers are normal. The doctor told us to up her dosage of iron to 180 mg. I have refused because from what I have read, I believe this is way too much iron. We had been giving her between 45 mg and 60 mg daily shouldn't her number at least being going up? One thing I did realize is that we were giving her orange juice at dinner before she took the iron because we read vitamin C helps absorb. BUT I then realized the orange juice is calcium fortified, could the calcium fortified be causing an absorption problem?
What other diseases / deficiencies can we test for to find out why she is not absorbing iron?
Thank you, XXXXXXX XXXXXXX
doctor
Answered by Dr. Hardik Sanghvi 1 hour later
Brief Answer:
You should search for blood loss also.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

She has iron deficiency anemia.
You are right calcium inhibit iron uptake and ascorbic acid acid help in iron absorption.

So avoid calcium fortified food along with iron.

No need to increase the dosage of iron.

There may be chronic blood loss that leads to persistent iron deficiency.

So go for stool examination for ova, cyst and occult blood test.

Other possible reason is malabsorption so go for celiac disease testing.

If not improved then injectable iron can be given.

Hope I have answered your question. if you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Hardik Sanghvi 3 hours later
Thank you Doctor. There has been a weird twist. I just received her Ferritin results and those have gone up into the normal range. In 6 months time her Ferritin has always been low and the iron has been constantly dropping, now the iron is at the lowest it has ever been yet the ferritin is up (at 30). Any thoughts?

One thing that kept coming up as I was researching is anemia of chronic illness/inflammation. Do you think we should look for something?

I have asked for Celiac testing, the doctor has been resistant to it because my daughter doesn't "fit the profile". But she has had issues with chronic constipation. I am just going to insist on the testing.

Thank you, XXXXXXX
doctor
Answered by Dr. Hardik Sanghvi 4 hours later
Brief Answer:
Ferritin can be increased in inflammation.

Detailed Answer:
Hi, dear, welcome back,
I have gone through your question. I can understand your concern.

Low ferritin level confirms the iron deficiency actually.

But normal or high ferritin does not rule out iron deficiency.

Ferritin is a acute phase reactant. That means it is a substance that increases in inflammation.

So, if she has some infection or inflammation then it leads to increase in ferritin level. It is misguiding finding. But iron remains low.

So it doesn't indicate proper iron statues.
At this time iron level is good indicator and it is very low. So she still have iron deficiency.

She should also check for reticulocytes count & CRP.

In chronic inflammatory anemia reticucytes count is low. In blood loss it is increased. So it can give some idea.

If she don't fit for mal-absorption then there must be some chronic blood loss or other condition which leads to persistent iron deficiency despite of treatment. So search for other cause also.

Hope I have answered your question. if you have any doubts then feel free to ask me. I will be happy to answer.

Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Hardik Sanghvi 13 hours later
Good Morning Dr.

Forgive me, but what is CRP refer to?
According to the normal range for the reticulocytes, she is still in the normal range, what are your thoughts?

Reticulocytes/100 RBC's, automated 1.13 % NORMAL RANGE: 0.47 - 2.40 %
Reticulocyte count, absolute, auto 0.060 M/uL NORMAL RANGE 0.020 - 0.109 M/uL

We have ruled out Celiac disease, they ran two tests for that:
TISSUE TRANSGLUTAMINASE IgG 0.13 Index NORMAL RANGE: <=0.90 Index
Tissue transglutaminase IgA 0.14 Index NORMAL RANGE: <=0.90 Index

One thing I am going to ask them to test for is B12 deficiency.

Thank you, XXXXXXX
doctor
Answered by Dr. Hardik Sanghvi 34 minutes later
Brief Answer:
It is c reactive protein.

Detailed Answer:
Hi, dear
Welcome back
I have gone through your question. I can understand your concern.

CRP is c reactive protein. It is a marker of inflammation. So if she has any inflammatory condition then CRP is increased.

So to rule out Inflammation CRP should be done.

Its good that you don't have celiac disease.

Reticulocytes count is normal. Its OK.

Check for blood loss. Because chronic blood loss may leads to persistent iron deficiency despite of treatment.

If she is not improving with oral iron then injectable iron can be tried.

Hope I have answered your question. if you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by : Dr. Raju A.T
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