What is the treatment for a 7-month-old baby with low hemoglobin?

Question

Hello doctor,

My 7-month-old baby had an infection with vomiting, and afterward, she stopped drinking formula milk. She prefers breastfeeding, but my wife does not produce enough milk. Her complexion also became pale. We had her hemoglobin checked one month before, and it was 4.0; then again, after a week, it was 5.4. We also did an electrophoresis and serum ferritin test, which showed a ferritin level of 247.21 ng/ml.

The doctor observed an HBA fraction of 3.4 and an HBF fraction of 87. Her red blood cell count was 2.88 mil/mm3, with a hemoglobin level of 5.4 g/dL, hematocrit at 18.8, MCV at 65.4, MCH at 18.6, MCHC at 28.5, and RDW CV at 49. The doctor advised a transfusion of 65 ml PRBC. After the transfusion on 26.03.2024, her hemoglobin increased to 6.3 g/dL, hematocrit to 22, RBC count to 3.2, MCV to 68, MCH to 20, MCHC to 29, WBC count to 15, neutrophils at 23, lymphocytes at 62, eosinophils at 05, monocytes at 10, and platelets at 151.

There is no family history of thalassemia, and I am married to my cousin. The doctor prescribed folic acid 5 mg. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Based on the provided information and reports (attachments removed to protect the patient's identity), it appears that your daughter has thalassemia. It is advisable to undergo a DNA (Deoxyribonucleic acid) test to determine the specific type of thalassemia she has. The primary focus should be on maintaining her hemoglobin levels, which may require regular blood transfusions. It is essential to monitor her Hb levels closely and continue with blood transfusions as needed. Also, it is suggested to conduct blood work for both parents, including CBC (complete blood count), peripheral smear, reticulocyte count, serum iron, serum ferritin, and high-performance liquid chromatography (HPLC). Even without a family history, if both parents are carriers of thalassemia, there is a 25 percent chance of a child having thalassemia disease.

Although there have been significant advancements in medical science, including potential cures for thalassemia, the immediate priority is to manage her Hb levels and monitor ferritin levels closely. Continue administering folic acid regularly and ensure she receives adequate vitamin D supplementation.

Feel free to reach out if you have further questions or need to discuss the issue in more detail.

Take care.