RT Book, Section
A1 Uko, Victor E.
A1 Mahajan, Lori A.
A2 Usatine, Richard P.
A2 Sabella, Camille
A2 Smith, Mindy Ann
A2 Mayeaux, E.J.
A2 Chumley, Heidi S.
A2 Appachi, Elumalai
SR Print(0)
ID 1114872656
T1 Nutritional Disorders in Children
T2 The Color Atlas of Pediatrics
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-176701-9
LK accesspediatrics.mhmedical.com/content.aspx?aid=1114872656
RD 2024/04/24
AB An  18-month-old  female  was  brought  in  for  evaluation  of  a  pale  appearance.  She  was  described  as  an  active  toddler  with  no  recent  fatigue,  melena,  or  hematochezia.  She  was  described  as  a  picky  eater  and  has  averaged  30  to  40  ounces  of  milk  intake  per  day  for  the  past  6  months.  Family  history  and  past  medical  histories  were  noncontributory.  On  exam,  height  and  weight  were  at  the  50th  percentile.  Examination  was  normal  except  for  a  pale  appearance,  spooning  of  her  nails  (Figure  63-1),  mild  tachycardia,  and  a  grade  II/VI  systolic  ejection  murmur  heard  best  over  the  left  lower  sternal  border.  Labs  were  significant  for  the  following:  Hgb  7.0  g/dl,  Hct  21.0  percent,  MCV  52  fL,  RDW  18  percent,  reticulocyte  count  1.9  percent,  total  iron  10  ug/dL  (30  to  140  ug/dL),  transferrin  saturation  9  percent  (11  to  46%),  and  ferritin  16  ng/mL  (18–300  ng/mL).  Peripheral  smear  showed  microcytosis,  hypochromia,  mild  anisocytosis,  and  polychromasia.