Transfusion-dependent anaemia of undetermined origin: a distinctive syndrome in paediatric medical tourism.
BACKGROUND
The underlying diagnosis of severe anaemic illnesses in children may not be easy to identify at times, especially when regular blood transfusion has been started.


METHODS
International children patients attending a haematology clinic for diagnostic evaluation were identified retrospectively if they had to receive repeated blood transfusions with an undiagnosed illness or an incorrect diagnosis. Their demographic data, presenting features, and eventual diagnosis were described.


RESULTS
Twelve children including 7 boys were enrolled from March 2007 to August 2011. Five came from Vietnam; 2 each came from Bangladesh and Indonesia; and 1 each from Hong Kong, Myanmar, and Ukraine. Their illnesses started at a mean age of 1.5 years (0.1 to 6.6) and they had been receiving blood transfusion for a mean duration of 2.5 years (0.1 to 9.9) years prior to the evaluation. Thalassemia major was the fi rst diagnosis in 5 cases; one had been treated for autoimmune haemolytic anaemia while the rest had not been given a diagnosis. After the evaluation, 4 children were diagnosed with Diamond Blackfan anaemia, 3 were diagnosed with hereditary spherocytosis, and one each with hereditary pyropoikilocytosis, congenital sideroblastic anaemia, congenital thrombotic thrombocytopenic purpura, transient erythroblastopenia of childhood, and autoimmune myelofibrosis associated with human immunodeficiency virus infection.


CONCLUSIONS
A definitive diagnosis can be identified in this cohort of children on medical tourism with severe anaemic illnesses requiring repeated transfusions with diagnostic approaches that circumvent the interference of transfused cells.
Children's Haematology and Cancer Centre, Mount Elizabeth Hospital, Singapore. anselm.cw.lee@gmail.com
Anselm C W
AC
Lee
D000740:Anemia / Q000175:diagnosis* / Q000628:therapy; D029503:Anemia, Diamond-Blackfan / Q000175:diagnosis; D001803:Blood Transfusion; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D057193:Medical Tourism; D012189:Retrospective Studies; D013103:Spherocytosis, Hereditary / Q000175:diagnosis