Elpis MANTADAKİS, Panagiota ZİKİDOU, Emmanouela TSOUVALA, Stavros THOMAİDİS, Athanassios CHATZİMİCHAEL

Severe iron deficiency anemia and anasarca edema due to excessive cow’s milk intake

The authors describe a 13-month-old girl who presented with progressivelyworsening anasarca edema that developed over the last three weeks alongwith increasing fatigue. Over the last several months she was consumingprogressively increasing amounts of fresh cow’s milk. Laboratory examinationson admission showed severe microcytic and hypochromic anemia (hemoglobin3.8 g/dl) and hypoferritenemia indicative of iron deficiency, while urinalysesshowed no proteinuria. The child was transfused with 13ml/kg packed redblood cells and approximately 2g/kg intravenous albumin. On the second andfourth hospital days, she received 100 mg of iron sucrose intravenously thatshe tolerated well. Eight months after the described events, she is healthywith normal hemoglobin for age, while she has no laboratory evidence ofcow’s milk protein allergy. Pediatricians should be aware of the association ofsevere iron deficiency anemia (IDA) and anasarca edema, and should screeninfants in their practice for anemia at the age of 12 months or sooner, ifrisk factors are present.

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1. Baker RD, Greer FR; Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126: 1040-1050.

2. Powers JM, Buchanan GR. Diagnosis and management of iron deficiency anemia. Hematol Oncol Clin North Am 2014; 28: 729-745.

3. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997; 277: 973-976.

4. Gupta PM, Perrine CG, Mei Z, Scanlon KS. Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients 2016; 8. pii: E330.

5. Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. de Benoist B, McLean E, Egli I, Cogswell M (eds). World Health Organization, Geneva: 2008: 7-13.

6. Waldmann TA, Wochner RD, Strober W. The role of the gastrointestinal tract in plasma protein metabolism. Studies with 51Cr-albumin. Am J Med 1969; 46: 275-285.

7. Woodruff CW, Clark JL. The role of fresh cow’s milk in iron deficiency. I. Albumin turnover in infants with iron deficiency anemia. Am J Dis Child 1972; 124: 18-23.

8. Woodruff CW, Wright SW, Wright RP. The role of fresh cow’s milk in iron deficiency. II. Comparison of fresh cow’s milk with a prepared formula. Am J Dis Child 1972; 124: 26-30.

9. Sakai Y, Sakai R, Yoshida N, Miyazaki S. Iron deficiency anemia and hypoproteinemia induced by fresh cow’s milk. Rinsho Ketsueki 1992; 33: 1691-1696.

10. Hamrick HJ. Whole cow’s milk, iron deficiency anemia, and hypoproteinemia: an old problem revisited. Arch Pediatr Adolesc Med 1994; 148: 1351-1352.

11. Vogelaar JL, Loar RW, Bram RJ, Fischer PR, Kaushik R. Anasarca, hypoalbuminemia, and anemia: what is the correlation? Clin Pediatr (Phila) 2014; 53: 710-712.

12. A n o n y m o u s . I r o n - d e f i c i e n c y a n e m i a w i t h hypoproteinemia in an infant. Nutr Rev. 1989; 47: 48-50.

13. Salstrom JL, Kent M, Liang X, Wang M. Toddlers with anasarca and severe anemia: a lesson in preventive medicine. Curr Opin Pediatr 2012; 24: 129-133.

14. Lundström U, Perkkiö M, Savilahti E, Siimes M. Iron deficiency anaemia with hypoproteinaemia. Arch Dis Child 1983; 58: 438-441.

15. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002; 360: 1347- 1360.

16. Mantadakis E. Advances in pediatric intravenous iron therapy. Pediatr Blood Cancer 2016; 63: 11-16.