A 14-month-old exclusively breastfed infant presents with pallor and recurrent infections. Hemoglobin is 7.8 g/dL with normocytic indices, neutrophil count is 400/mm3, and reticulocytes are low. Iron and folate therapy for 6 weeks produced no response. Bone marrow shows vacuolated erythroid precursors. Which deficiency best explains these findings?

• A Iron deficiency
• B Transient erythroblastopenia of childhood
• C Vitamin B12 deficiency
• D Copper deficiency ✓

Explanation

Acquired copper deficiency produces a microcytic to normocytic anemia with neutropenia that is refractory to iron, along with vacuolated marrow precursors and osteoporosis. Breast milk is low in copper, so prolonged exclusive breastfeeding is a recognized risk. D12 deficiency causes macrocytic anemia with neurological signs rather than neutropenia, and transient erythroblastopenia occurs in older children without neutropenia.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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