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Congenital diaphragmatic hernia and iron deficiency anemia / Konjenital Diafragmatik Herni ve Demir Noksanligi Anemisi.

To the Editor,

The case described by Dr. Sarper and her colleagues in their letter to the editor, entitled "Severe iron deficiency anemia due to late presentation of congenital diaphragmatic hernia in a toddler", was not a late but rather a delayed diagnosis case since iron deficiency anemia was diagnosed in this patient at least a year earlier with intermittent vomiting (1). The diagnosis of a diaphragmatic hernia might be delayed up to at least 5 years of age as reported by us. This entity should not be extremely rare, since at least 9 patients in an 8-year period were seen by us (2). We suggest that it should be looked for especially in very severe cases of iron deficiency anemia with frequent vomiting. Although restricted transfusion (<7 g/dL) was recommended in adult patients with upper gastrointestinal bleeding (3), as in the authors' patients very severe anemia (<4 g/dL) was detected in 7 of our 9 patients.


(1.) Sarper N, Zengin E, Kilic SC, Tugay M, Aydogan A, Kayabey O. Severe Iron Deficiency Anemia due to late Presentation of Congenital 'Diaphragmatic Hernia ih a Toddler. Turk j Hematol 2012; 29:430-431

(2.) Yetgin S, Hicsonmez G, Altay C, Ozsoylu S. Diafragma hernisine bagh demir eksikligi anemisi. Cocuk Sag ye Hast Dergisi 1973;16:209-213.

(3.) Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastroindestinal bleeding. New Eng j Med 2013;368:11-21.


In this case report (1), the tide was "Late presentation of congenital diaphragmatic hernia...." because it is known that over 90% of the patients will be diagnosed either antenatally or will present with respiratory distress in the few hours of life (2). The patient's admission to our Center was at the age of 3 and she had a one-year history of intermittent vomitting and iron deficiency anemia. Ozsoylu suggests that iron deficiency anemia due to diaphragmatic hernia is not very rare. Congenital diaphragmatic hernia occurs in about 1 in 3000 births (2). lt is not clear how many of these cases present with iron deficiency anemia. Similar to our message in the last paragraph, Ozsoylu also emphasizes that. in patients with very severe iron deficiency anemia and Frequent vomiting diaphragma hernia must be considered in the differential diagnosis. We did not have the chance to reach Yetgin et al.'s paper as it is not present online (3).

Address for Correspondence: Sinasi OZSOYLU, M.D.,

Fatih University. School of Medicine, Department of Hematology. Ankara, Turkey Phone: +90 312 235 41 88 E-mail:

Received/Gelis tarihi : Februar) 17. 2013

Accepted/Kabul tarihi : February 18. 2013


(1.) Sarper N, Zengin E, kilic SC, Tugay M, Aydogan A, Kayabey O. Severe Iron Deficiency Anemia due .to late Presentation of Congenital Diaphragmatic Hernia in a Toddler. Turk j Hematol 2012; 29:430-431.

(2.) Davenport M Holmes K. Current management of congenital diaphragmatic hernia. Br J Hosp Med 1995;53:95-101.

(3.) Yetgin S, Hicsonmez G, Altay Ozsoylu S. Diafragma hernisine bagh demir eksik1igi anemisi. Cocuk Sag ve Hast Dergisi 1973;16:209-213.

Sinasi Ozsoylu

Fatih University School of Medicine, Department of Hematology, Ankara, Turkey

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Title Annotation:Letter to the Editor
Author:Ozsoylu, Sinasi
Publication:Turkish Journal of Hematology
Article Type:Clinical report
Geographic Code:7TURK
Date:Jun 1, 2013
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