oa Journal of Endocrinology, Metabolism and Diabetes in South Africa - Primary congenital hypothyroidism complicated by persistent severe anaemia in early infancy : a case report with a literature review : case study



Although anaemia is a common finding in adults with hypothyroidism, there is a general paucity of studies on anaemia in infants with congenital hypothyroidism. The degree of anaemia is usually mild to moderate, with a haemoglobin concentration that is rarely less than 8-9 g/dl. The associated anaemia in hypothyroidism is generally normochromic and normocytic, and occasionally mildly macrocytic. This heterogeneity has been attributed to coexisting deficiencies of iron, vitamin B12 and folic acid, largely due to impaired absorption. Anaemia in hypothyroidism has been linked to impaired haemoglobin synthesis due to a deficiency of thyroxine (T4). There is evidence of a direct effect of the thyroid hormone on erythropoiesis. The pathogenesis of anaemia in hypothyroidism has been linked to either a lack of erythropoietin production, or a physiological adaptation to the decreased tissue oxygen requirements resulting from a decrease in the basal metabolic rate. The red cell life span is normal and the results of ferrokinetic studies are compatible with hypoproliferative erythropoiesis in hypothyroidism.


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