Next week’s topic is on iron deficiency anemia (IDA). Always an important topic in gen peds, as IDA is the most significant nutrient deficiency worldwide and also in the US.
- Case and discussion
- AAP Iron Deficiency Anemia clinical report 2010
- Julie Rivers' (Heme-Onc fellow) RCP on IDA
Take home points on IDA:
- Epidemiology: Since the 1970s we have made significant progress identifying and screening for iron deficiency, but it remains the most common nutrient deficiency worldwide. Almost 10% of toddlers have been diagnosed with iron deficiency in a national U.S. sample, and many believe this may be underestimated.
- Significance: Iron deficiency is associated with poorer cognitive and social-emotional outcomes and has persistent effects, but treatment can improve outcomes.
- Risk factors: include prematurity, cow milk consumption before 1 year of age, drinking more than 24 oz/day of cow’s milk per day after 1 year, low income status, menstruating adolescents, elite athletes, and restricted diets for any reason.
- Screening: Iron deficiency screening is recommended for all children between 9-12 months and again among adolescent females within a year of menstruation. Labs recommended vary. At a minimum Hct/Hgb identifies anemia and adding ZPPH (inexpensive and widely available) can help identify iron deficiency that precedes anemia (but note ZPPH is also elevated from lead and anemia of chronic disease). The Mentzer index, equal to the MCV divided by the RBC count, can help to pinpoint iron deficiency. An index >13.5 is suggestive of iron deficiency, <11.5 is suggestive of thalassemia minor. (Remember, the bone marrow cannot produce RBCs normally in IDA, so the RBC count is lower and the ratio is higher.)
- Treatment: treat iron deficient children with 3-6 mg/kg of elemental iron daily until sufficient and then 2-3 months after to ensure adequate iron stores. Typically we repeat measures 1 month after starting therapy to ensure a response and ensure compliance and/or do additional work-up if not improving.