An 8-month-old boy with a 1-month history of breath-holding spells and erythroblastopenia is reported from the Naval Medical Center, San Diego, CA. Hemoglobin concentration was 7.6 gm/dl (Hgb A 89.8%, F 7.7%, A2 2.4%), hematocrit 22.6%, reticulocytopenia (0.8%), serum iron 95 mcg/dl, and total iron binding capacity 245 mcg/dl. With iron therapy, breath-holding spells immediately resolved, while the hemoglobin gradually returned to normal after 2 months (Hgb 10.6 g/dl, hematocrit 38.5%). [1]

COMMENT. Iron-deficiency anemia and transient erythroblastopenia have both been associated with breath-holding spells and other neurologic and behavioral disorders. The immediate control of breath-holding following iron supplementation, despite persistence of the anemia, is indicative of a specific role of iron in autonomic nervous function.

Effectiveness of iron therapy on breath-holding spells is reported from Jordan University of Science and Technology, Irbid, Jordan [2]. Of 33 children treated with ferrous sulfate solution orally (5 mg/kg day for 16 weeks) 88% had a complete or partial control of BHS, whereas in 34 receiving placebo only 6% resolved. Patients with the lower hemoglobin levels at baseline (8.6 gm/dl) had a favorable response whereas those with a mean Hgb 10.6 gm/dl failed to benefit. A low total iron binding capacity was also predictive of a favorable response. Response to iron was correlated with improved blood indexes. Both pallid and cyanotic forms of breath-holding may be associated with iron-deficiency anemia.

Iron deficiency anemia and learning difficulties were correlated in a case-control study of 130 children at Belfast Community Paediatric Unit, N Ireland [3]. LD children were more likely to be anemic, had lower serum iron, and failed audiometry tests more frequently than controls. Tests for fragile X, thyroid disorders, and amino acid abnormalities were negative. Iron deficiency anemia and otitis media with hearing impairment should be excluded in the evaluation of children with learning disorders. See Ped Neur Briefs March 1997; 11:21, for a report of iron deficiency as a cause of stroke, and Progress in Pediatric Neurology I, Chicago, PNB Publ, 1991;pp397-398, for further reference to iron deficiency and breath-holding, headache, pseudotumor, diplopia, papilledema, and cranial nerve palsies.