Pediatric Clinical Advisor: Instant Diagnosis and Treatment, by Lynn C. Garfunkel MD, Jeffrey Kaczorowski MD, Cynthia

By Lynn C. Garfunkel MD, Jeffrey Kaczorowski MD, Cynthia Christy MD

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Extra resources for Pediatric Clinical Advisor: Instant Diagnosis and Treatment, Second Edition

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This may result in a macrocytic anemia, thrombocytopenia, and hypersegmentation and reduction of granulocytes. 2 Folate deficiency anemia EPIDEMIOLOGY & DEMOGRAPHICS  Body stores of folic acid are small in comparison to daily requirements; therefore deficiency may result relatively quickly from inadequate folate intake or poor folate absorption.  Folate requirements are greatest per kilogram in newborn infants, young children, and pregnant and lactating women.  Other groups with increased folate requirements are those with malabsorption syndromes, premature infants, children receiving chronic antiepileptic therapy, and children with chronic hemolysis with or without anemia.

Excessive intake of cow’s milk impairs adequate intake of other foods rich in iron.  Proteins in the cow’s milk may cause bleeding from irritation of the gastrointestinal (GI) tract in infants, compounding iron deficiency.  The small amount of iron in breast milk is absorbed efficiently but is not sufficient for the growing infant after 6 months. CLINICAL PRESENTATION History  Pallor may be apparent.  When anemia is severe (hemoglobin < 5 g/ dL), of irritability, anorexia, and exertional intolerance, reflect the systemic effects of iron deficiency.

However, dietary deficiency may be seen in vegans (who consume no milk, eggs, or animal products) because vegetables do not contain vitamin B12.  Newborn infants whose mothers are deficient in vitamin B12 may develop severe B12 deficiency in the first few weeks of life.  Inborn errors of vitamin B12 metabolism also can cause inadequate B12 availability in newborns and infants.  Vitamin B12 combines with intrinsic factor produced by parietal cells in the stomach and is absorbed in the terminal ileum.

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