Question 1

Q: A 6-month-old exclusively breastfed infant presents with irritability and poor weight gain. Physical examination reveals pallor, tachycardia, and a systolic ejection murmur. Laboratory studies show hemoglobin 8.2 g/dL, MCV 68 fL, and ferritin 6 ng/mL. The mother reports exclusively breastfeeding without iron supplementation. Apply appropriate management for this condition.

Start oral iron supplementation and continue breastfeeding. ***Start oral iron supplementation and continue breastfeeding*** - The infant displays **microcytic anemia** (low MCV) and low **ferritin**, diagnostic of **Iron Deficiency Anemia (IDA)** likely due to exclusive breastfeeding beyond 4 months without supplementation. - **Oral elemental iron** at 3-6 mg/kg/day is the first-line treatment, and breastfeeding should be encouraged to continue for its nutritional and immunological benefits. *Immediate packed red blood cell transfusion* - Transfusion is generally reserved for patients with **hemodynamic instability** or severe anemia, usually defined by a **hemoglobin <7 g/dL**. - This infant is stable despite the murmur and tachycardia, which are physiological compensations for chronic anemia, not signs of heart failure. *Switch to iron-fortified formula exclusively* - While iron-fortified formula is an option for feeding, it is unnecessary to discontinue **breastfeeding** to treat IDA. - Breastfeeding provides optimal nutrition and antibodies; adding **medicinal iron** is the preferred strategy to correct the deficit. *Start iron supplementation and add vitamin C-rich foods* - Although **Vitamin C** enhances iron absorption, 6-month-old infants are just starting solids and should not rely on diet alone to correct a significant deficiency. - Management must focus primarily on the **therapeutic dose of iron** rather than dietary tweaks which are insufficient for moderate anemia. *Continue exclusive breastfeeding and reassess in 2 months* - Delaying treatment is inappropriate as IDA can lead to **neurodevelopmental delays** and worsening fatigue or failure to thrive. - At 6 months, an infant's **prenatal iron stores** are depleted, so intervention is required immediately upon diagnosis.

Question

A 6-month-old exclusively breastfed infant presents with irritability and poor weight gain. Physical examination reveals pallor, tachycardia, and a systolic ejection murmur. Laboratory studies show hemoglobin 8.2 g/dL, MCV 68 fL, and ferritin 6 ng/mL. The mother reports exclusively breastfeeding without iron supplementation. Apply appropriate management for this condition.

Accepted Answer

Start oral iron supplementation and continue breastfeeding

Answer

Immediate packed red blood cell transfusion

Answer

Switch to iron-fortified formula exclusively

Answer

Start iron supplementation and add vitamin C-rich foods

Answer

Continue exclusive breastfeeding and reassess in 2 months

Nutritional requirements and disorders — MCQs

Nutritional requirements and disorders — MCQs

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