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Dr. Chip
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 31182
Experience:  20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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My 10 month old was recently diagnosed with a low iron level.

Customer Question

Hi my 10 month old was recently diagnosed with a low iron level. His Haemoglobin was also low. His iron was 4. The range is 14-31 as deemed as normal. He is anaemic. He was put on a iron supplement for two weeks and had further blood tests two weeks later. He had reticuloytes, ferritin and full blood count taken. Doctor said absorption was ok but Haemoglobin was still low. No lower just the same what does it mean that his Haemoglobin is still low but his iron level has improved. He had to stay on the tonic for another month then recheck bloods. What do you think. Should I be worried. Could it be leukemia? Shoukd I be asking for more tests. He is taking 5mls of iron per day. Whag do you think
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.

At this point, there is no reason for concern about other conditions beyond the iron deficiency. When someone is severely iron deficient, it will take some time to build up iron stores and see significant improvement in the hemoglobin level. The typical red blood cell lives for about 3-4 months, so the number that are made in one day is relatively low, and even if the production is doubled, it will take some time for the blood cells to increase. The fact that the reticulocytes have increased is a good sign, as the reticulocytes are the new red blood cells made by the bone marrow.

If the hemoglobin is still not improving after another month, then it would be appropriate to be concerned about other conditions, but it is far more likely that the levels in a month will be improving.

If I can provide any further information, please let me know.
Customer: replied 2 years ago.
If the Haemoglobin levels are still low in a month. Can you let me know what tests I should Hve carried out on my son.also reticuloytes were not checked initially. The took them recently but said he was in the normal range. Think it was 40? They didn't take his iron level this time. Just the ferritin. Are they the same.
Expert:  Dr. D. Love replied 2 years ago.
The iron test measured the amount of iron in the blood, while ferritin is a protein that is a measure of iron stores.

If the hemoglobin is still low in a month, then there would need to be evaluation for other nutritional deficiencies, such as folic acid and vitamin B12. There should be detailed evaluation of the structure of hemoglobin to look for hereditary defects, such as thalassemia. There should be assessment of haptoglobin which looks for evidence of increased destruction of red blood cells, such as from hemolytic anemia. If these tests do not indicate a cause, then an aspiration of bone marrow would be appropriate.
Customer: replied 2 years ago.
Should they not Hve done an iron check to compare to the previous one which was 4. Instead they took the ferritin. Why do you think they did this? If after a month they do a blood check and everything is normal. Should he stay on the iron? Of come off it and go back to be rechecked again to compare levels
Expert:  Dr. D. Love replied 2 years ago.
It is the personal preference of the doctor which labs to check, but I routinely check a ferritin whenever I check an iron level.

I do not expect everything to be normal after one month, since the typical red blood cell lives for 3-4 months, but I do expect that it will be significantly better at one month.

We typically prefer to continue iron supplementation for at least several months after the blood has been built back to normal, to help replenish all the iron stores.
Customer: replied 2 years ago.
Hi again since we last spoke my little guy is on an iron supplement 5mls for 10 weeks now. He had his bloods done at 8 weeks but the iron , haemogloblin, and ferritin were not back up to normal levels. The iron was 9(starting off it was 4), haemolglobin was 13 this hadn't moved very much the consultants advice was to stay on the iron for another month and then retest all the levels. He will have been on the iron for 3 months then.
Do you think I should be more concerned if the levels are not normal after 3 months. Should I push to have the vitamin b12 and folic acid checked. Can u do this with a blood test? Also my little one has 10 teeth. Will the iron affect his teeth in the form of discolouration. Is is in liquid form. Should I be pushing the consultant for more tests? Why is it taking so long to reach normal levels ?
Also he has ketosis pilaris on his legs and arms. Is it worth going to a dermatologist or will they just say there is nothing u can do.
Customer: replied 2 years ago.
Relist: Other.
Need more info on the original answer
Expert:  Dr. Chip replied 2 years ago.

Hi. I'm a different expert here

First off, no, I wouldn't be concerned that his iron, ferritin, and haemoglobin levels aren't as yet up to normal--they are getting better so he needs to continue on the iron supplement

As for the B12 and folate levels, they can be checked with blood work.

The iron supplement won't affect the color of his teeth.

As for the keratosis pilaris, there are treatments like laser therapy and topical cream so a dermatologist should be consulted

Let me know if I covered all your additional questions

Customer: replied 2 years ago.
Hi Thank u for your reply. We r going for his next bloods in 2 weeks. Do u think it would be worth getting the b12 and folic acid checked? Is it folic acid or folate test? Could it be thalassaemia? Should I do a blood test for haptoglobin or can u do a blood test for this. How long do u think he will be on iron supplements even if his blood results are normal next time. Regarding the keratosis pilaris. Why do some kids get it? Will he grow out of it? It is not itchy but very bumpy. Is it important to go to a dermatologist for this?
Expert:  Dr. Chip replied 2 years ago.

Well folic acid and folate are basically the same. I'd check the B12 and the folate levels just to complete the anemia workup but this sounds like it's purely an iron deficiency anemia problem. No, this isn't thalassemia.

Haptoglobin is a blood test but I really see no reason to check his

If his tests are normal in another two or three months I wouldn't continue the iron supplements beyond that point but I would check his levels in another three months after that.

No one knows exactly what causes keratosis pilaris and he'll probably outgrow it and it isn't dangerous so the dermatologist isn't essetial right now

Customer: replied 2 years ago.
Are there ant topical creams you can recommend for KP?
He will be on iron 3 months at next blood test. If consultant stops it then do u think it would be wise or continue it on for awhile. He said if levels are not normal in two weeks he would take him in for tests. What do you think he will do. Are a lot of babies anaemic or is this unusual
Expert:  Dr. Chip replied 2 years ago.

Tretinoin cream can be used but at his age I'd not use it as yet.

You need to follow the consultant's directions if he wants to stop the iron at some point.;

A good many babies are anemic, yes. As for further testing, he might want to do a GI workup to check for low gastic acid production as a cause for poor iron absorption

Customer: replied 2 years ago.
What is a GI workup
Expert:  Dr. Chip replied 2 years ago.
Measuring gastric pH, an upper endoscopy, and perhaps a screening for an H pylori infection
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 31182
Experience: 20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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Customer: replied 2 years ago.
Hi
My little guy is on his iron supplement 3 months now and had his levels checked again today. He is currently taking 5 mls per day. His iron was 14 an improvement from 4. The normal range is 14-31. So he is still in the lower end of the range. His haemogloblin was 11.5 previously 9. Normal range is 11.5-14. So still lower end. His ferritin was 24. Normal range between 8-100. He also had his vit b12 and folate checked. Don't hve those results yet.
Just want your advice . Do u think he should stay on the iron supplements until levels are higher or stop and see if levels drop off.
Will the folate and vitamin b 12 results tell us much.
Also had haptogloblius taken. This takes 2 weeks. What does that show.
Expert:  Dr. Chip replied 2 years ago.
Hi--for us to go on any further I need you to accept the offer more discussion time offer I sent you
Customer: replied 2 years ago.
Sorry I did not receive anything. If I need to pay again what do I do. My email is***@******.***
Expert:  Dr. Chip replied 2 years ago.
Well then what we need to do is have you rate my above answer first then please
Customer: replied 2 years ago.
Hi
My little guy is on his iron supplement 3 months now and had his levels checked again today. He is currently taking 5 mls per day orally. His iron was 14 an improvement from 4. The normal range is 14-31. So he is still in the lower end of the range. His haemogloblin was 11.5 previously 9. Normal range is 11.5-14. So still lower end. His ferritin was 24. Normal range between 8-100. He also had his vit b12 and folate checked. These were higher than normal. What does that mean.
Just want your advice . Do u think he should stay on the iron supplements until levels are higher or stop and see if levels drop off.
Will the folate and vitamin b 12 results tell us much.
Also had haptogloblius taken. This takes 2 weeks. What does that show.
I am meeting the consultant and wZnt to be armed with questions. Should I ask for any further tests. Do u think he should stay on the iron.
Expert:  Dr. Chip replied 2 years ago.
Sorry but before we go on I must insist you rate my service to you
Customer: replied 2 years ago.
Rating done
Expert:  Dr. Chip replied 2 years ago.

Thanks.

I think he needs to stay on the iron for about one more month

The folate and vitamin B12 levels are likely to be normal.

Haptoglobin is to check for hemolytic anemia which I don't think he has

Customer: replied 2 years ago.
Is there anything you feel I should ask the consultant? Any further tests. How would we know if he has thalasaemia?
What happens if he comes off it and levels drop off again.
Expert:  Dr. Chip replied 2 years ago.

Have you mentioned to the consultant about thalassemia and is there a history of that in your or your husbands family?

And what specifically has the consultant told you about his anemia so far?

Customer: replied 2 years ago.
Nothing at all. He put him on the iron and hvnt seen him since. All results and instructions were given through his secretary. He doesn't speak to patients over the phone. I Hve an apt on Saturday and as you can imagine I need to make sure I get all my questions asked and concerns relayed. I just wanted a second opinion. Thanks to this site I asked to Hve his folate and vit b12 checked. He had not mentioned doing it. His secretary said the folate and b12 was probably high due to the iron. Is this correct
Expert:  Dr. Chip replied 2 years ago.

I have no idea why the secretary would say that and of course, the secretary isn't a physician.

Unless there's a history of Thalassemia in the families I see no reason to check for that

I would ask specifically what the cause of the anemia is--if it's an iron deficiency then why is he deficient--is it an absorption problem? I would also ask if that's not the case and he's losing blood somehow what is causing that--is it from his GI tract?

Customer: replied 2 years ago.
One last question Luke also has keratosis pilaris. Any suggestions on what to do about this. Should we see a dermatologist
Expert:  Dr. Chip replied 2 years ago.
That would be best--either for laser treatment or for a retinoid cream

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