**10. References**


children are given because of the elevated heart rate of the doctor, rather than the patient. If used, packed red cells should be given slowly under the direction of a pediatric hematologist or other experienced clinician to avoid the risk of fluid overload due to the

Response to therapy depends on the disorder, the severity of the deficiency and compliance, not only with the prescribed iron, but in removing the bleeding source. Especially in children whose bleeding is due to excess whole milk, the response to oral iron will be slow or nonexistent if the milk intake is not severely cut back or eliminated from the diet. Intake of acid foods such as orange juice aid iron absorption, and hypochorhydric states, such as produced by proton pump inhibitors, has been reported to impair absorption (Sharma et al., 2004). The amount of iron in typical vitamin supplements (about 10 mg of elemental iron daily), while sufficient to prevent deficiency, is well below the 3-6 mg *per kg* required as treatment. If compliant with therapy, the hemoglobin should rise by 1 g/dL or more during the first week, along with an increased reticulocyte count, and the hemoglobin should be nearly normal by 4-6 weeks. Iron therapy should be continued for several weeks beyond normalization of the hemoglobin, as pointed out previously, in order to replenish iron stores

Iron deficiency anemia is the leading cause of microcytic anemia when both the anemia and the microcytosis are severe. Regardless of the age of the patient, gastrointestinal disorders are the most frequent causes, and most of these are due to chronic gastrointestinal bleeding. The frequency of the specific causes of the bleeding varies with age. In most cases of severe microcytic anemia in children, as in adults, referral to a gastroenterologist is appropriate or

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**9. Acknowledgment** 

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**Section 3** 

**Pathophysiology and Treatment of** 

**Pancreatic and Intestinal Disorders** 

