Anemia, Iron-Deficiency

Key Features

• Defined as a hemoglobin more than 2 standard deviations below normal for age and gender

• Iron stores are sufficient in normal-term infants for the first 4 months of life

• Iron stores may be reduced in

  • Premature infants

  • Infants with low birth weight

  • Infants with neonatal anemia or in those with perinatal blood loss or subsequent hemorrhage

• Breast milk is low in iron relative to cow's milk and fortified formulas, and without iron supplementation, iron deficiency may develop in exclusively breast-fed children

Clinical Findings

• Pallor, fatigue, irritability

• Poor dietary intake of iron (ages 6–24 months)

• Chronic blood loss (age > 2 years)

• Microcytic hypochromic anemia

• History of pica

Diagnosis

• Screening for anemia should be performed at about 12 months of age with determination of hemoglobin concentration and an assessment of risk factors for iron deficiency

• If the hemoglobin is < 11 mg/dL or there is a high risk for iron deficiency, an iron evaluation should be performed

• There is no single measurement that documents the iron status; recommended tests include serum ferritin and C-reactive protein or reticulocyte hemoglobin concentration

Treatment

• If a child has hemoglobin of 10–11 mg/dL at the 12-month screening visit

  • Can be closely monitored or

  • Empirically treated with iron supplementation with a recheck of hemoglobin in 1 month

• If anemia is present, recommended oral dose of elemental iron is 6 mg/kg/d in three divided daily doses

• Parenteral administration of iron is rarely necessary

• Iron therapy results in an increased reticulocyte count within 3–5 days, which is maximal between 5 and 7 days

• Treatment is generally continued for a few additional months to replenish iron stores