A 12-month-old with microcytic, hypochromic anemia and pallor but no hepatosplenomegaly most likely has which condition?

A 12-month-old with microcytic, hypochromic anemia and pallor but no hepatosplenomegaly most likely has which condition?

• A. Hereditary spherocytosis
• B. Iron-deficiency anemia
• C. Lead intoxication
• D. Sickle-cell anemia

Answer: (B)

The key idea is recognizing iron-deficiency anemia as the most common cause of a microcytic, hypochromic picture in a toddler. When iron availability is low, hemoglobin synthesis drops, so red cells become smaller (microcytosis) and paler (hypochromia), leading to pallor. By 12 months, iron stores are usually depleted unless dietary iron intake is adequate, making iron deficiency a very likely diagnosis in this age group. The absence of hepatosplenomegaly weighs against hemolytic or storage disorders, which often involve an enlarged liver or spleen. For example, hereditary spherocytosis causes extravascular hemolysis with splenomegaly, not simply microcytosis. Lead poisoning can cause a microcytic anemia, but there are often additional signs (neuro or GI symptoms and basophilic stippling) that aren’t described here. Sickle-cell disease typically presents with normocytic anemia and has different clinical features such as pain crises and splenic changes over time. Taken together, the presentation fits iron deficiency best.

The key idea is recognizing iron-deficiency anemia as the most common cause of a microcytic, hypochromic picture in a toddler. When iron availability is low, hemoglobin synthesis drops, so red cells become smaller (microcytosis) and paler (hypochromia), leading to pallor. By 12 months, iron stores are usually depleted unless dietary iron intake is adequate, making iron deficiency a very likely diagnosis in this age group. The absence of hepatosplenomegaly weighs against hemolytic or storage disorders, which often involve an enlarged liver or spleen. For example, hereditary spherocytosis causes extravascular hemolysis with splenomegaly, not simply microcytosis. Lead poisoning can cause a microcytic anemia, but there are often additional signs (neuro or GI symptoms and basophilic stippling) that aren’t described here. Sickle-cell disease typically presents with normocytic anemia and has different clinical features such as pain crises and splenic changes over time. Taken together, the presentation fits iron deficiency best.