Sometimes, It’s Just Black and White: Dark Urine and Pallor in a 2-Year-Old Boy

Abstract

A 2-year-old Chinese boy was admitted to the hospital after 2 days of pallor and fatigue and 1 day of dark urine. There was no recent history of illness, although his mother reported a 1-week history of intermittent, subjective fevers. There was no history of recent travel, no history of recent trauma, no sick contacts, no pertinent family history, no changes in diet, and no medications. His past medical history was significant for self-limited nosebleeds, which had increased in frequency over the few days before admission. On examination, the patient was afebrile and tachycardic, with an oxygen saturation of 88% on room air. He was pale and tired-appearing on arrival. He was in no respiratory distress, and there was no hepatosplenomegaly or lymphadenopathy. His skin examination was notable for jaundice, but there were no bruises, petechiae, or rash. He was noted to pass cola-colored urine while in the hospital. His chest radiograph was normal. Laboratory evaluation revealed a normal serum electrolyte level and normal serum urea nitrogen and creatinine levels. A complete blood count (CBC) revealed the following: a white blood cell count of 20,700 per mL with normal differential, hemoglobin of 4.1 g/dL, hematocrit of 11.8%, a platelet count of 365 000 per mL, a mean corpuscular volume of 88.2 femtoliters, and a red cell distribution width of 20.5%. Question What Are the Current Recommendations for the Evaluation of Anemia in the Pediatric Population? Discussion Anemia is estimated to affect up to 20% of the American population during childhood. 1 It can be defined on the basis of age-and sex-specific percentile criteria for hemoglobin concentration. The Centers for Disease Control and Prevention, for example, uses the fifth percentile and below to define anemia, resulting in a lower limit of normal range of 11.0 to 11.9 g/dL for children under age 12 and 12.5 to 13.5 g/dL for children ages 12 to 18 years. 2 Reference ranges for neonates vary considerably on the basis of factors such as gestational age and day of life, although standardized reference values have been established. 3 The diagnostic approach to anemia combines a thorough history and physical examination with laboratory testing aimed at identifying which cell lines are affected, characterizing the patient' s erythrocytes, and differentiating between aplastic and consumptive processes. The CBC, which is used to confirm the presence of anemia, will also reveal whether the patient has abnormalities in the leukocyte or thrombocyte lines. Several acquired or inherited diseases can contribute to peripheral cytopenia, and many,

Favism: Clinical Features at Different Ages

“…Wadowski B et al [ 32 ] reported, in 2016, the case of a 2-year-old Chinese male child admitted to the hospital with paleness, malaise, and dark urine, as well as a one-week history of intermittent fever. The patient was treated with multiple packed red cell transfusions, which resulted in the resolution of the symptoms.…”

Cyanosis Due to Methemoglobinemia as the Presenting Sign of Glucose-6-Phosphate Dehydrogenase Deficiency in a Child: Diagnostic and Clinical Implications

“…The patients were from North Africa, Central Africa, Middle East, Mediterranean, and Far East, whereas 3 of the articles did not report the origin of the patient. The triggers varied and included fava beans, 9,10,13,15,16 Chinese herbal tea, 16 diabetic acidosis, 19 infection from respiratory syncytial virus, 11 rasburicase, 12,14 antimalarial drugs, 8 ofloxacin, 18 norfloxacin and metronidazole, 17 whereas in 1 case no obvious cause was revealed. 7 Our case is the first to be reported from Greece, however, the patient was a refugee from Syria.…”