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Refractory Iron-deficiency Anemia and Autoimmune Atrophic Gastritis in Pediatric Age Group: Analysis of 8 Clinical Cases

Miguel, Natalina MD; Costa, Emília MD; Santalha, Marta Jr MD; Lima, Rosa MD; Vizcaino, José Ramon MD; Pereira, Fernando MD; Barbot, José MD

Journal of Pediatric Hematology/Oncology: March 2014 - Volume 36 - Issue 2 - p 134–139
doi: 10.1097/MPH.0000000000000069
Original Articles

Introduction: Refractory iron-deficiency anemia with no obvious etiology in pediatric age can be a puzzling problem. Screening of iron malabsorption conditions, including autoimmune atrophic gastritis (AAG), is emerging as a priority in the investigational procedure.

Materials and Methods: Retrospective analysis of clinical process of children/adolescents with the diagnosis of AAG.

Results: Eight patients (aged between 4.7 and 18 years old) were identified. The diagnosis was triggered on the basis of high serum gastrin levels and strong positivity of antiparietal cell antibodies. Upper endoscopy and biopsy revealed atrophic gastritis in all patients, with 2 of them with intestinal metaplasia. Four patients presented with Helicobacter pylori infection object of eradication therapy. After a medium follow-up of 36.6 months, antiparietal cell antibodies and hypergastrinemia did not show evidence of regression. Of the 3 patients who underwent endoscopic reevaluation, a similar anatomo-pathologic pattern was observed in 2 and intestinal metaplasia in 1 patient. Normalization of hematological parameters was achieved, using alternative iron formulas.

Conclusions: AAG must be recognized as a pathology affecting pediatric patients. Gastric autoimmune lesion is a chronic process with potential evolution to malignancy. Management guidelines in childhood are not available. Their elaboration is important considering an important risk factor in these age group: a long life expectancy.

*Department of Pediatrics, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real

Departments of Hematology

§Pediatric Gastroenterology

Pathology, Centro Hospitalar do Porto, Oporto

Department of Pediatrics, Centro Hospitalar do Alto Ave, Guimarães, Portugal

The authors declare no conflict of interest.

Reprints: Natalina Miguel, MD, Serviço de Pediatria do Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-514 Vila Real, Portugal (e-mail:

Received August 20, 2012

Accepted October 16, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.