Severe Iron Deficiency Anemia presenting as Blue Sclera.

A report describes a case of a 12-month-old Japanese boy who presented with cyanotic breath-holding spells. He started crying excessively, followed by holding his breath until he became cyanotic. He showed normal physical and neurologic milestones for his age and had no history of bone fractures or any signs or history of external or gastrointestinal bleeding. 

On presentation, the patient was alert and playful. His heart rate, respiratory rate, and body temperature were recorded as 154 beats per minute, 32 breaths per minute, and 36.8°C, respectively. Physical examination revealed pallor and a bluish tinge to the sclera. Suspicion for underlying iron deficiency anemia directed a blood test, which revealed microcytic anemia with hemoglobin 6.0 g/dL, mean corpuscular volume 44 fL, serum iron 18 μg/dL, and serum ferritin 5.3 ng/mL. 

The patient received an iron supplement of 3 mg/kg/d, which increased his hemoglobin to 9.0 g/dL at the 1-month follow-up, further confirming the diagnosis of iron deficiency anemia. The color of his sclera also improved, along with anemia.

Iio K, Ishida Y. Blue Sclera in an Infant with Severe Iron Deficiency Anemia. The Journal of Pediatrics. 2022;247:169-170. DOI:https://doi.org/10.1016/j.jpeds.2022.05.031