A preterm infant born at 29 weeks, now 7 weeks old and formula fed, develops pallor, reticulocytosis and pitting edema over the dorsum of both feet. Hemoglobin is 7.8 g/dL with fragmented red cells on smear and increased in vitro red cell fragility to oxidant stress. Which nutrient deficiency best explains these findings?

• A Iron
• B Folic acid
• C Pyridoxine
• D Vitamin E ✓

Explanation

Preterm infants have low vitamin E reserves and reduced absorption, predisposing them to hemolytic anemia between roughly 4 and 8 weeks, historically associated with diets rich in polyunsaturated fatty acids. Oxidant-induced red cell membrane damage causes hemolysis, reticulocytosis and characteristic edema of the dorsum of the feet that resolves with vitamin E therapy. Iron deficiency produces hypochromic microcytic anemia without hemolysis or edema, and folate deficiency is macrocytic.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.