Should echocardiogram be undertaken routinely when a child has severe iron deficiency anaemia?

ABSTRACT

Iron deficiency anaemia (IDA) is common in children. Treatment usually consists of oral iron therapy and, if severe, inpatient hospitalisation with blood transfusion. Providers may also undertake an echocardiogram, depending on availability and the severity of anaemia. A male toddler with nutritional IDA, haemoglobin of 1.7 g/dL (the lowest level in the literature) and hypertension had left ventricular hypertrophy (LVH) on the initial echocardiogram. He was managed acutely with judicious blood transfusion, followed by oral iron supplementation and anti-hypertensive medication at discharge. Repeat echocardiogram a month later demonstrated slight improvement of the LVH but the hypertension persisted at follow-up 6 months later. There was complete resolution of the findings a year later. In chronic nutritional IDA, there can be structural cardiac changes which can affect the acute management and requires close follow-up. It is important to use echocardiography in such severe cases.

Abbreviations: CHF: congestive heart failure; CM: cardiomyopathy; DCM: dilated cardiomyopathy; ICU: intensive care unit; IDA: iron deficiency anaemia; IVSd: interventricular septum in diastole; LA: left atrium; LV: left ventricle; LVEDD: left ventricular end-diastolic diameter; LVH: left ventricular hypertrophy; LVM: left ventricular mass; LVPWd: left ventricular posterior wall end-diastole; PRBC: packed red blood cells.

KEYWORDS:

• Anaemia
• iron deficiency
• hypertrophy, left ventricular
• cardiomegaly

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Riwaaj Lamsal contributed to the conception of the research and drafted the manuscript. Jerry Walkup contributed to collecting and interpreting the data. Both authors critically revised and approved the final manuscript.

IRB approval

The need for approval was waived by the institutional review board.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.