A 15-month-old toddler drinks more than 1 litre of cow milk daily and eats little else. He is pale, irritable, and tachypneic. Hemoglobin is 6.5 g/dL, MCV is 62 fL, RDW is elevated, and Mentzer index is 13.5. What is the expected finding on further evaluation?
- A Elevated free erythrocyte protoporphyrin with basophilic stippling
- B Normal serum ferritin with normal transferrin saturation
- C Serum ferritin less than 10 ng/mL with low transferrin saturation ✓
- D Markedly elevated HbA2 on electrophoresis
Correct answer: C. Serum ferritin less than 10 ng/mL with low transferrin saturation
Explanation
Excessive unfortified cow milk intake is the leading cause of iron deficiency anemia in toddlers, through poor iron content, occult gut blood loss, and displacement of iron rich foods. Microcytosis with high RDW and a Mentzer index above 13 supports iron deficiency over thalassemia trait. Confirmation comes from low ferritin and low transferrin saturation. Basophilic stippling suggests lead poisoning, and raised HbA2 indicates beta thalassemia trait.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.