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Treatment for CHRONIC ANEMIA not corrected by IRON supplements.

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respected doctor

i am father of 9 years male child on chronic anemia not corrected by iron supplements from age 3to till now.his hbg was not crossed above 11gm/dl inspite of iron and vitamin c supplements.tests for alpha and beta thal done in cmc vellore which is negative and feces occult blood test is negative,

he is mild factor 7 deficient which corrected by plasma and no history of bleddings and brusing

deworming protocol was done once in 3 months, currently taking rx elemental iron 150mg a day (three different salts used (ferrous succinate ,iron as chelate complex,ferrouscalcium citrate ) and becadexin caps od (which contains b6 2mg) for the past 2 weeks

i have attached 6 pdf blood reports in info@doctorspring.com please let me know what was the exact status of my child , whether to continue iron and mvt,whether its ok to use 3 different iron salt at a same if not please advice for further


Category: Pediatric Hematologist

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Category: ICU/ Critical Care Specialist
Dr. Saptharishi L G is online now

Expert:  Dr. Saptharishi L G replied 4 Days.

Dear Parent,
Thank you for your consult at DoctorSpring.com. I can understand your situation.
This problem perplexes me, not because of its medical complexity, but because of how complex we have made it. A haemoglobin of 10-11 gm% is on the lower side for sure, but not worthy of such concern. You have got a battery of investigations done for your son. I have gone through each of those reports personally and find no reason to worry. In fact some of them were not required in the first place.
The mean corpuscular volume and RDW are borderline abnormal. I find nothing else abnormal. Nearly 75% of Indian children are anaemic as per the latest stats. So it is no surprise that Indian children have an average haemoglobin that is lower than that seen in western countries. However, I advise you not to worry much about a haemoglobin of 10-11 g%. As he approaches puberty (with the production of testosterone) his haemoglobin would be pushed into the 12-14 range that we desire.
Do not fret. Just ensure that he gets a nutritious diet. Include jaggery, green leafy vegetables and fruits in his daily diet. Ensure daily physical activity. He will blossom into one healthy young man and let us desist from giving him the label of 'CHRONIC ANEMIA'.
There is no recommendation to use 150 mg/day of Iron for children. Stop the combination of three preparations and use any one of those. Use 75 mg/day only. Can give him folic acid and vitamin B complex tablets. There is no need to do anything else. Leave him alone. Please do not get any more investigations. Your son is going to be absolutely fine.
Would be glad to answer any follow-ups.
Regards
Dr. Saptharishi L G


Patient replied :

Thanks doctor You make clear finally please give me product name and dosage for iron folic and bc


Expert:  Dr. Saptharishi L G replied 3 Days.

Hello. Thank you for posting the follow up.
I will prescribe the following medicines for him :

1. Syrup VITCOFOL (5ml=30 mg) 5 ml, twice daily - to be taken two hours after food.
2. Syrup A-Z or Syrup ENTIQUITY 5 ml, twice daily.

If you follow a healthy diet and give him the above mentioned medicines, he will blossom into a healthy young man. Please do not be worried.
Feel free to discuss further,
Regards


Patient replied :

Respected doctor Thanks for your reply I have planned to give livogen tabs 1 tab od Supradyn novartis 1/2 tabs od It's enough or else needed He is little bit short stature shall we add ostocalcium od Please advice


Expert:  Dr. Saptharishi L G replied 2 Days.

Dear Parent,
Tab. Livogen is an adult preparation with 150 mg Iron and 1500 microgram Folic acid. I request you to take a pediatric formulation as suggested by me at the dosage prescribed by me.
You can give supradyn 1 tab OD
What do you mean by 'little bit short stature' ?
What is his height?
Is it appropriate for age?
What is your and your wife's height?
Is your child's height in line with his genetic potential (based on mid-parental height)?
Have you documented his rate of height gain per year?
I think we are getting too empirical here. We cannot prescribe anything and everything to our children just based on hearsay.
Even if he is a bit short, how do you think Osteocalcium will help him? Osteocalcium is calcium phosphate. We do not use calcium phosphate in older children. We prefer Calcium carbonate preparations. Please do not give even one unnecessary drug to your child. Every drug has its side-effects including excessive calcium.

I think we need a shift in the parental thought process. The more drugs that we give our child, the more satisfied we feel with ourself. That is quite the opposite. Calcium is not going to help short stature (even if your child was actually short). And I do not go by 'little bit short stature'.
Thank you.


Patient replied :

PARENTS HT --- FATHER 6.3 MOTHER 5.7
SON AGE 9 YEARS 9 MONTHS ----- WEIGHT 29.30KGS HEIGHT 141 CMS
PLEASE ADVICE


Expert:  Dr. Saptharishi L G replied 1 Day.

Hello. Thank you for posting the follow up.
His height is fine and i do not thin you should be worried. Just give him a nutritious diet. And also give him the medicines as i recommended before.
1. Syrup VITCOFOL (5ml=30 mg) 5 ml, twice daily - to be taken two hours after food.
2. Syrup A-Z or Syrup ENTIQUITY 5 ml, twice daily.
He will grow up to be healthy. Kindly continue the above mentioned treatment. And you can get back to me after a month, and let me know if there has been any improvement. More than any supplement, please give him a nutritious diet. He will definitely grow up to be a healthy young man.

Regards


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
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