Reaction to Iron Supplements or Something Else Entirely?!?

If anyone has had this experience, please let me know...

Our toddler has Beta-Thalassemia minor and also had very low iron serum levels, we were told by Gen to give him iron (12-15 mg/daily) and that we would retest his levels after a month. We saw ped hem recently and had new CBC and iron serum + iron ferritin level tested. His iron in just 5-6 wks improved greatly and his hemoglobin went from 8.3 to just over 10, a big improvement! My joy was a bit short lived however when I got his lab results and was able to review everything else...VERY confused. While he had those good improvements for iron these were the rest of his numbers...*important note, our toddler had not been sick at all, before or after this blood work.



HGB  10.4 L (10.5-14.0) - I have personally never seen this range used before and could find no age/gender application for it!
HCT  33.2 L (33-39)
Absolute Neutrophils  1 L (1.8-9.2) - I am very concerned about this being so low.
WBC  10.0 (4.6-12.4)
RBC  5.27 (3.7-5.3) - this went up quite a bit, usually very close to low end of normal but now towards high end
MCV  62.9 L
MCH - Not Given
MCHC - 31.3 (30-36)
RDW%  20.7 H (10.5-14.1) - concerned about this as well, before iron his RDW was 14.7%, highest ever before iron was 16.9% when RSV was suspected!
Platelets  393 (150-440) - this has decreased significantly and is now in normal range
Seg Neutrophils  10 L (39.2-73.9) - another big concern, his seg neut has never been this low, lowest was 23 during same RSV episode
Lymphocytes  86 H (17.6-40) - same concern only with how high it is, it hasn't ever been this high
Monocytes  4 L (4.7-11.6)
Eos Not Given
Baso Not Given

Anisocytosis 2+      Microcytic 3+         Hypochromasia 1+

What?!? I was told that his Microcytic +1 (in older blood work) was due to just the iron anemia, so my question is why now that is iron is so much better, is his microcytic morph now a 3+, more severe? His Anisocytosis has also gone from 1+ to 2+ - all of these changes since the iron supplements were introduced plus a rash for one month now on his tummy and lower chest area only! He tested negative for strep, no fever, no symptoms of a virus or any illness at all! Could this be a reaction to the iron or maybe something else going on entirely? I am starting to wonder about immunological disorders/disease, I feel like something is getting missed here.

Any thoughts are totally welcome

Thal minor also causes microcytic red blood cells. In fact, their presence is used as part of the diagnosis of thal minor. You cannot eliminate them and variations in percentages is not significant, because testing is somewhat subjective, as it also is with platelet counts. If he did not have microcytic RBC's, he would not be thal minor. Although RDW is used in diagnosis of anemia, it is agreed that it is one of the worst indicators of anything and the range varies greatly in anemic patients. Its use now as a measure is only when it is combined with the other factors.

The report is positive. However, it does appear the the current form of iron may be causing an allergic reaction on the skin. Talk to your doctor about trying a different form of iron. Reactions to iron are common and often several forms of iron have to be tried to find one that is tolerable.

Hi Andy,

Thank you for your reply! We are trying a new vitamin, this one has the recommended iron intake but with about half of the amount of the fat soluble vitamins in it, so hopefully we will see some improvement. The rash doesn't seem to bother him at all, so we will keep watching it with the new supplement to see if there is any changes.

Thanks,
Sarah