A 14-month-old child from a low-income family presents with pallor, angular stomatitis, cheilosis, and a smooth, glossy tongue. Hemoglobin is 7.2 g/dL, MCV 65 fL, serum ferritin 4 ng/mL, and serum folate is low. The peripheral smear shows microcytes and hypersegmented neutrophils. What is the MOST likely explanation for this combined deficiency?
- A Selective folate malabsorption syndrome
- B Pernicious anemia with intrinsic factor deficiency
- C Concurrent iron and folate deficiency due to dietary inadequacy (cereal-based low-diversity diet) and rapid growth demands ✓
- D Sideroblastic anemia with secondary folate trapping
Explanation
In children aged 6–24 months with poor dietary diversity and rapid growth, concurrent iron and folate deficiency is the most common explanation. Cereal-based complementary feeds are low in both absorbable iron and folate. The peripheral smear showing microcytes (iron deficiency pattern) alongside hypersegmented neutrophils (folate deficiency marker) confirms the dual deficiency. Pernicious anemia due to intrinsic factor deficiency is extremely rare in this age group and typically presents in infants of mothers with pernicious anemia. Sideroblastic anemia shows ring sideroblasts on bone marrow iron stain. Management requires supplementation with both elemental iron and folic acid plus dietary counseling.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.