A 14-month-old infant presents with pallor and lethargy. Dietary history reveals that he drinks 1.5 liters of whole cow's milk daily and consumes minimal solid food. Laboratory testing shows hemoglobin 7.2 g/dL, MCV 62 fL, elevated red cell distribution width (RDW), low serum ferritin, and low transferrin saturation. What is the diagnosis?

Answer and explanation

Correct answer: B. Iron deficiency anemia

  1. Step 1: Excessive cow's milk consumption (> 500 mL/day) in toddlers fills satiety, displaces iron-rich foods, and causes occult micro-hemorrhage from the intestinal mucosa.
  2. Step 2: Microcytic anemia with high RDW and low serum ferritin establishes iron deficiency anemia.
Answer
Iron deficiency anemia.
Why not the others: 'Thalassemia minor trait' produces a severe microcytosis with normal or elevated RBC count, low RDW (Mentzer index < 13), and normal ferritin; 'Anemia of chronic disease' features normal or high ferritin; 'Lead poisoning' can co-exist but isolated dietary milk excess is the classic primary cause.

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