Childhood Diseases

Question
Posted by: tlee | 2011-11-25

Q.

low haemoglobin and iron

Dear Dr

You gave us some advice recently re my 31 month old son who was constantly ill and unable to shake infections despite 4 months of 7.5ml ferrimed daily.

You suggested blood tests which showed low iron and a Ferritin level of 26 and haemoglobin of 10.9.

We then did a stool test which said haemoglobin was present.
We suspected milk allergy due to the sever cows milk protein allergy he had at 3 months when weaned.

Ha had a gastroscopy and colonoscpy which revealed no polyps/growths/lesions. The surgeon also took biopsies of colon lower gi, esophagus and stomach lining and a few others - the results show no allergy, infection or disease (they tested for cealiac as well). So no explanation for haemoglobin in stool.

At the same time we did a RAST Blood test including a paediatric mix which showed a count of 0.02 which I have been told is much too low to be serious or be causing bleeding.

His current Ferritin is 25. Our paed has told us to continue with 7.5ml Ferrimed daily and have another blood test in 3 or 4 months.

I have 3 questions:

1. Is the haemoglobin found in his stool something to worry about?
2. Do we need to investigate further or can we just follow the paed''s advice to continue with Ferrimed and retest in a few months?
3. When my son is on the iron supplement he poos in his pants. No matter how much Dupholac or any other stool softener we give him and despite having the iron at dinner time with food. As soon as he is off the iron for 2 days he starts pooing in the toilet again. Do you have any advice on how we can get the iron in without the result of him pooing in his pants? It seems like we will need to give the iron supplement for another 4 months at least and most likely for a year or two so we need to resolve this problem.

Thanks so much for any advice you can give us.


Expert's Reply

A.

Paediatrician

Haemoglobin or blood should not be present in your son's stools. This means that he is losing small amounts of blood due to slight bleeding in his intestines. The most likely cause is a condition called 'eosinophilic gastroenteropathy'. The usual cause of this is a cow's milk intolerance. Your son should be on a complete milk free diet including avoiding all dairy and hidden sources of milk. Read all labels as many common foods such as margarine may contain milk protein.He will need to use an amino acid formula such as Pepticate [expensive, but will help greatly to overcome his problem]It would be best to consult a dietician regarding your son's milk-free diet.
Ferrimed seems to be causing your son to lose control of passing stools. Of course giving him a stool softener such as Duphalac is not a good idea and will aggravate this problem.Duphalac should be stopped.It would be best to first solve the problem of his stool blood loss before giving him any more iron supplement at this stage.

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