title: Severe anemia in 3 toddlers with gastric lactobezoar.
abstract: BACKGROUND
  Anemia in toddlers may result from many disorders including excessive feeding with cow's milk. Another sequel of age-inadequate cow's milk nutrition may be gastric lactobezoar (GLB), a dense lump of coagulated milk and mucus in the stomach.
  
  
  METHODS
  3 toddlers presented with a history of excessive intake of full cream cow's milk, abdominal distension, vomiting, dehydration, fatigue, marked pallor and tachycardia.
  
  
  METHODS
  Diagnostic imaging revea-led large GLBs as the likely origin of the abdominal symptoms. Laboratory evaluation showed severe anemia with depleted iron stores and signs of protein catabolism. Non-cow's milk-induced causes of anemia including defects of erythropoiesis, hemoglobin structure, RBC-enzymes and blood coagulation, hemolysis, immune disorders, infection, inflammation, extraintestinal hemorrhage, nephropathy were - according to the available data - unlikely to cause the anemia in our patients. Thus their anemia is thought to be due to age-inadequate cow's milk nutrition leading to 1) low intake, decreased absorption/bioavailability and increased intestinal loss of iron, and 2) GLB which induced blood loss following mechanical irritation of the gastric mucosa and vomiting causing high gastric pH and decrease in duodenal iron absorption.
  
  
  CONCLUSIONS
  The anemia in our patients is due to both exaggerated feeding with cow's milk and adverse effects of GLBs. This hypothesis is supported by the finding that, after erythrocyte transfusion, iron substitution, age-adapted nutrition and GLB-dissolution, the anemia did not recur. We propose to include GLB in the differential diagnosis of anemia in cow's milk fed small children.
authors.affiliation: Department of Pediatrics, Medical University, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Klein-Franke
authors.forename: G
authors.initials: G
authors.lastname: Kropshofer
authors.forename: I
authors.initials: I
authors.lastname: Gassner
authors.forename: B
authors.initials: B
authors.lastname: Meister
authors.forename: C
authors.initials: C
authors.lastname: Salvador
authors.forename: S
authors.initials: S
authors.lastname: Scholl-Bürgi
authors.forename: T
authors.initials: T
authors.lastname: Mueller
authors.forename: P
authors.initials: P
authors.lastname: Heinz-Erian
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000818:Animals; D001317:Austria; D001630:Bezoars / Q000150:complications* / Q000175:diagnosis; D003131:Combined Modality Therapy; D054242:Emigrants and Immigrants; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use; D005751:Gastric Lavage; D006801:Humans; D007223:Infant; D008892:Milk; D009093:Mucus; D013270:Stomach / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D005296:Ferrous Compounds; C020748:ferrous sulfate