Too Much of a Good Thing? Cerebral Sinovenous Thrombosis Due to Excessive Milk Intake Associated Anemia

Abstract

<jats:sec><jats:title>Introduction:</jats:title><jats:p> In young children, excessive cow’s milk intake causes iron-deficiency anemia, which is associated with hypercoagulable states. We present a case series of 4 toddlers with excessive milk intake iron-deficiency anemia and cerebral sinovenous thrombosis. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Retrospective chart review of 4 patients was performed for patients with cerebral sinovenous thrombosis and iron-deficiency anemia secondary to excessive milk intake. Iron-deficiency anemia was defined as hemoglobin &lt;11 mg/dL, mean corpuscular volume &lt;70 fL, and serum ferritin &lt;12 μg/L. Excessive milk intake was defined as consumption of &gt;24 oz daily. Clinical, laboratory, and radiographic features were reviewed. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Age ranged from 12 to 24 months. Average hemoglobin, hematocrit, mean corpuscular volume, and ferritin levels were 6.1 g/dL, 22.7 g/dL, 52.7 fL, and 3.2 ng/mL, respectively. Daily milk consumption ranged from 40 to 60 oz. All patients presented with focal neurologic deficits, including seizures in 3. The location of cerebral sinovenous thrombosis varied, and 3 patients had venous infarcts, one of them hemorrhagic. All patients had a limited diet and were described as “picky eaters” by their parents, and only 1 had transitioned of a bottle. All patients were treated with anticoagulation, iron supplementation, and extensive dietary counseling to reduce cow’s milk intake. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Iron-deficiency anemia due to excessive milk intake is an important and preventable etiology of pediatric cerebral sinovenous thrombosis. Focused anticipatory guidance is necessary for at-risk groups to prevent this neurologic emergency. </jats:p></jats:sec>

Correspondence on “Too Much of a Good Thing? Cerebral Sinovenous Thrombosis Due to Excessive Milk Intake Associated Anemia”

“…We read with great interest the recent article on cerebral sinovenous thrombosis due to excessive milk intake associated anemia by Farias-Moeller et al in the recent issue of your journal. 1 The authors highlight a relevant point of avoidance of prolonged milk feeding beyond infancy and the potential neurologic problems that can ensue. We have the following concerns, and their clarification will improve the understanding of the readers: The “hypercoagulability panel” done in the study needs to be elaborated for the benefit of the readers.…”