Severe Iron-Deficiency Anemia and Hypoalbuminemia Associated With Excessive Cow’s Milk Intake Driven by a Strong Belief in the Health Benefits of Cow’s Milk in a 16-Month-Old Girl: A Case Report

Iron-deficiency anemia is common in infants and toddlers; however, excessive cow's milk intake may lead to severe anemia and related complications. A 16-month-old girl presented with fever and progressive somnolence. She appeared unwell and had conjunctival pallor, pitting edema of the lower extremities, and a grade 4/6 systolic ejection murmur. Laboratory evaluation revealed severe microcytic hypochromic anemia (hemoglobin, 2.6 g/dL). Iron studies showed low serum iron (9 µg/dL) and ferritin (1.7 ng/mL) with a total iron-binding capacity of 286 µg/dL, consistent with iron deficiency. Serum albumin was markedly low (1.6 g/dL). The caregiver reported cow's milk intake of approximately 1.0-1.5 L/day since early infancy. Chest radiography showed cardiomegaly (cardiothoracic ratio, 58%), and echocardiography demonstrated left ventricular dilation with preserved systolic function (ejection fraction, 62%). She was treated with leukoreduced packed red blood cell transfusion (10 mL/kg each on hospital days one and two), oral iron supplementation, and dietary counseling, including restriction of cow's milk intake. Edema and overall clinical status improved, and she was discharged on hospital day seven. In infants and toddlers presenting with pallor, somnolence, and edema, cow's milk intake should be quantified, and severe anemia and potential complications (e.g., hypoalbuminemia and thrombosis) should be promptly assessed.