Title: Refractory Anemia Associated Iron Overload in a Four-Year-Old Child with Chronic Transfusion-Dependent Microcytic Anemia Related to Abdominal Tuberculosis: A Case Report
Authors: Mustafa Ibrahim Abbas¹, Ahmed Khalifa Mousa², Khalid Abdelsamea Mohamedahmed, Heba Hassabalnabi Abdallah
Volume: 10
Issue: 9
Pages: 136-139
Publication Date: 2026/09/28
Abstract:
Background: Iron overload is a serious complication of chronic blood transfusion therapy in pediatric patients with transfusion-dependent anemia. Early recognition through iron studies is essential to prevent irreversible organ damage. Case Presentation: A four-year-old Sudanese boy presented with persistent pallor since six months of age requiring repeated blood transfusions, the last occurring 40 days before evaluation. Previous investigations for ?-thalassemia, sickle cell disease, and glucose-6-phosphate dehydrogenase deficiency were reportedly negative. Two months before presentation, he underwent abdominal surgery for intestinal obstruction secondary to abdominal Tuberculosis, no hepatospenomegly. Laboratory evaluation demonstrated severe anemia (hemoglobin 5.3 g/dL), microcytosis (MCV 78 fL), Normal Reticulocytes count (1.5%), leukocytosis with absolute lymphocytosis, thrombocytosis (788 ×10³/?L), serum ferritin>2000 ng/mL, serum iron 266 ?g/dL, transferrin saturation 70.3%, and normal TIBC (378 ?g/dL), indicating marked transfusional iron overload. No evidance of hemolysis, normal bilirubin (total bilirubin 0.5 mg/dl and direct bilirubin 0.3 mg/dl). Conclusion: This case emphasizes the importance of routine monitoring of iron status in children receiving chronic blood transfusions. Early diagnosis and initiation of iron chelation therapy are essential to reduce morbidity associated with iron overload.