Paediatricsmiddle twist
A 20-month-old boy of Greek-Australian parents is investigated for pallor and irritability. He drinks about 1.2 litres of full-cream milk a day from a bottle, including overnight, and refuses meat. His stools are normal, he has never vomited, and his weight and length have tracked the 25th centile since six months; development is normal. Haemoglobin is 84 g/L (105-135), mean cell volume 61 fL (70-86), red cell count 4.1 x10^12/L (3.9-5.3), red cell distribution width 19 per cent (11.5-14.5) and platelets 545 x10^9/L (150-450). Which one of the following is the most likely cause of his anaemia?