영유아에서 철결핍빈혈

Abstract

The etiology of iron deficiency anemia (IDA) in infancy (9-24 months) are diet, parasite, blood loss and Helicobacter pylori. Diet is the most common etiology of IDA in infancy. If infant with breastfeeding beyond 6 months of life is premature, low birth weight and twin, the risk of IDA will increase. Hookworm infestation could be an etiology in some underdeveloped countries. Blood loss could be caused by hospitalization (blood sampling especially in premature newborn), diet-related (exposure to a heat-labile protein in whole cow’s milk), and lesion of gastrointestinal tract. The diagnosis of IDA is simple (a hemoglobin level ＜11 g/dL and serum ferritin ＜12 mg/L). But most of the patients we encounter have acute infections (respiratory infections, urinary tract infection and acute otitis media etc) at sampling time. Because ferritin is an acute phase reactant, the level of ferritin cannot stand true iron status in an acutely infected infant. We recommend two methods to help differentiate pure IDA and anemia of inflammation. One is to check ratio of transferrin receptor and ferritin. The other is to check ferritin after CRP is normalized. Because the international marriage increases, thalassemia is also included in differential diagnosis of microcytic anemia of infant.