A 2-year-old Israeli girl was born after 30 weeks' gestation to parents of Ethiopian origin. She was referred to the hematology clinic because of longstanding anemia and was treated with parenteral iron. She underwent additional examination because of poor response to the treatment and poor compliance. The patient had no relevant family history.
Physical and psychomotor development were normal except for a wide base gait. Laboratory findings were as follows: white blood cell count, 8.3×109/L; hematocrit, 0.25; hemoglobin, 80 g/L; platelet count, 307×109/L; mean corpuscular volume, 55 fL; mean corpuscular hemoglobin, 17.5 pg; and mean corpuscular hemoglobin concentration, 318 g/L. Blood chemistry was normal except for an elevated alkaline phosphatase level of 350 U/L. Results of a hematologic workup revealed a low serum iron level of 2.5 μmol/L, total iron-binding capacity of 84 μmol/L, a low iron saturation level of 0.03, and a low ferritin level