Congenital Diaphragmatic Hernia and Iron Deficiency Anemia

The case described by Dr. Sarper and her colleagues in their letter to the editor, entitled “Severe iron defi ciency anemia due to late presentation of congenital diaphragmatic hernia in a toddler”, was not a late but rather a delayed diagnosis case since iron defi ciency 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 defi ciency 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.