Severe Iron Deficiency Anaemia Due to a Selective Diet: Early Recognition and Prevention of Cardiac Complications

Key words: Anaemia, Iron deficiency, Microcytosis, IRIDA

Iron deficiency anaemia is the most common form of anaemia in childhood. Due to its slow onset it may present with subtle clinical signs, despite extremely low haemoglobin levels. The paper reports the case of a 1-year-and-10-month-old girl admitted for profound anaemia (Hb 1.7 g/dl), in the context of a highly selective diet based almost exclusively on cow’s milk, associated with poor weight gain and developmental delay. Laboratory findings showed severe microcytic hypochromic anaemia with marked iron deficiency and vitamin D deficiency; cardiac evaluation revealed dilated cardiomyopathy with severe systolic dysfunction, consistent with high-output heart failure secondary to chronic anaemia. Combined treatment with red blood cell transfusion, iron and vitamin supplementation, heart failure therapy and a structured nutritional intervention led to the normalisation of hematologic parameters, catch-up growth and marked improvement in cardiac function at three-month follow-up. This case highlights how a preventable condition may progress to potentially severe yet reversible complications and underscores the importance of careful dietary history, cardiac assessment in cases of severe anaemia and early multidisciplinary management.