Severe Acute Iron Poisoning in a Toddler: Unconventional Therapy of Exchange Blood Transfusion as an Extracorporeal Intervention before Deferoxamine Administration
Lere P. Oluwadare
*
Division of Early Childhood Development, Neurology & Infectious Diseases, Department of Paediatrics & Child Health, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Pauline K. Akowundu
Division of Neonatology, General Paediatrics & Adolescent Medicine, Department of Paediatrics & Child Health, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Christian E. Amiwero
Department of Haematology & Blood Transfusion Services, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Olanrewaju A. Ajayi
Department of Medicine, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Adeola S. Ajoba
Division of Early Childhood Development, Neurology & Infectious Diseases, Department of Paediatrics & Child Health, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Ayodeji T. Olukayode
Division of Neonatology, General Paediatrics & Adolescent Medicine, Department of Paediatrics & Child Health, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Adebobola C. Amire
Division of Neonatology, General Paediatrics & Adolescent Medicine, Department of Paediatrics & Child Health, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Gideon T. Onyema
Department of Emergency & Critical Care Medicine, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Idongesit E. Ekanem
Department of Clinical Pharmacy, Therapeutics & Toxicology, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria.
Odutola I. Odetunde
Division of Paediatric Nephrology, Department of Paediatrics & Child Health, Redeemer’s Health Village, Redemption City, Mowe, Ogun State, Nigeria, Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Nigeria, Nsukka, Nigeria and Paediatric Nephrology Unit, Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Accidental exposure to hazardous substances with life-threatening sequelae is an aspect of paediatric care that deserves special attention. This commonly occurs in children under five years of age, particularly those aged 2–4 years. We present a 2-year-old girl who was brought to our facility after multiple episodes of vomiting and the passage of bloody stools. She had not been previously ill, and the onset of symptoms was sudden. At one point, the caregiver provided information suggesting the ingestion of a toxic dose of haematinic tablets. At presentation, she was conscious but in hypovolaemic shock. An anti-shock regimen comprising three boluses of intravenous normal saline was administered. Her initial urine output was suboptimal but subsequently normalised (1.5–2.7 mL/kg/h). Because of initial logistical difficulties that precluded administration of the specific antidote, exchange blood transfusion was used as an extracorporeal intervention. Intravenous deferoxamine was subsequently administered. The child's cardiopulmonary parameters were closely monitored. She was discharged after 96 hours of intensive clinical monitoring. She has been reviewed twice in the outpatient department and remains clinically stable. She is scheduled for visits every 3 months for 18 months after hospital discharge to monitor for any significant long-term sequelae. Unintentional exposure to toxic substances is a significant contributor to injuries in the paediatric age group. Caregivers should be aware of this risk. In severe paediatric iron poisoning, delayed access to deferoxamine may necessitate interim management options; however, exchange blood transfusion remains a non-standard intervention with limited supporting evidence.
Keywords: Acute iron poisoning, toxicity, exchange blood transfusion, deferoxamine, toddler, haemorrhagic gastrointestinal complications