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Puzzling (IRIDA-Like and Hemolytic) Anemia in a Child With Idiopathic Pulmonary Hemosiderosis

Motokazu Nishikado1, Hitoshi Awaguni1, Jun Shinozuka1

  • 1Departments of Pediatrics.

Journal of Pediatric Hematology/Oncology
|December 30, 2021
PubMed

Insights

Pediatric idiopathic pulmonary hemosiderosis (IPH) can be initially mistaken for anemia. Early diagnosis of IPH in children is crucial, as demonstrated by a case diagnosed in 12 months.

Area of Science:

  • Pediatric Pulmonology
  • Hematology
  • Rare Diseases

Background:

  • Idiopathic pulmonary hemosiderosis (IPH) diagnosis in children is often delayed by preceding anemia.
  • Unexplained anemia can mimic other conditions, complicating early IPH detection.

Purpose of the Study:

  • To highlight the diagnostic challenges of pediatric idiopathic pulmonary hemosiderosis (IPH).
  • To present a case of pediatric IPH with a shorter diagnostic timeline.

Main Methods:

  • Case report of a pediatric patient presenting with anemia.
  • Clinical evaluation including gastric aspirate analysis for hemosiderin-laden macrophages.
  • Review of diagnostic timelines for pediatric IPH.

Main Results:

  • A 5.8-year-old female initially presented with iron-refractory iron deficiency and hemolytic anemia.
  • At 6.8 years, the patient was diagnosed with IPH, exhibiting classic triad signs and positive gastric aspirate findings.
  • The diagnostic period from initial anemia to IPH diagnosis was 12 months, shorter than previously reported ranges (16-30 months).

Conclusions:

  • Anemia can precede and mask the diagnosis of pediatric idiopathic pulmonary hemosiderosis (IPH).
  • Prompt recognition of IPH signs, even in the presence of anemia, can shorten the diagnostic delay.
  • Gastric aspirate analysis is valuable for confirming IPH in pediatric cases.

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