DIAGNOSTIC APPROACH IN REFRACTORY ANEMIA: A PEDIATRIC CASE REPORT.

Introduction: Iron-deficiency anemia is a prevalent hematological condition in children, characterized by low hemoglobin levels often caused by inadequate iron intake or blood loss. However, there are cases where anemia persists despite adequate iron therapy, being classified as iron-refractory feriprival anemia. The objective of this case report is to highlight the crucial role of a rigorous diagnostic approach in the management of refractory iron-deficiency anemia in children, focusing on identifying the underlying cause. Case Report: We present the case of a 10-year-old boy diagnosed with autism spectrum disorder and iron deficiency anemia for approximately 2 years, who underwent oral iron therapy without any improvement. The patient presents with severe normochromic, normocytic anemia, elevated ferritin levels, as well as increased inflammatory markers (ESR, C-reactive protein). Suspicion of malabsorption arises, as the patient was tested negative for Helicobacter pylori infection and celiac disease, but elevated calprotectin levels were discovered. Subsequent findings raise suspicion of an inflammatory bowel disease. Also, antinuclear antibodies (ANA) were tested and found to be at the upper limit of normal. Following this, the patient was scheduled for a colonoscopy; however, prior to the procedure, a test for Clostridium difficile was conducted, yielding a positive result. Discussions : These findings led to the suspicion of an inflammatory bowel disease, potentially underlying the refractory iron-deficiency anemia in this patient. The importance of a meticulous diagnostic approach is highlighted, focusing on identifying the underlying cause to ensure appropriate management and prevent potential complications. Conclusions: This case exemplifies the critical role of meticulous diagnostic investigations in elucidating the complex etiology of refractory iron-deficiency anemia in pediatric patients. Despite initial therapeutic efforts targeting iron deficiency, the persistent anemia prompted a comprehensive diagnostic workup, revealing potential underlying factors such as malabsorption and inflammatory bowel disease. [ABSTRACT FROM AUTHOR]