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.