Aluminum-induced microcytosis in a child with moderate renal insufficiency

A child with moderate renal failure, on high doses of aluminum compounds for treatment for hyperphosphatasemia, presented with unexplained microcytosis. The patient also had psychomotor delay. On discontinuation of aluminum, microcytosis reversed in 2 months. Four months later, psychomotor development improved. Children with renal failure, on aluminum supplementation, should be carefully monitored for toxicity. Microcytosis may be a clue to aluminum toxicity in such patients.