Iron Deficiency Anemia

1 y/o with h/o prematurity, immigration from a developing nation presents for fatigue/irritability. Parents report pt regularly tries to eat dirt/clay; deny recent viral illness, rash, joint pain. Growth delay, glossitis, systolic murmur, skin pallor on exam.

• Labs

  • CBC shows low hemoglobin, low MCV, elevated RDW, and reticulocyte count <2%; MCV/RBC > 13

  • Iron studies show low ferritin, elevated TIBC

  • Lead level WNL

• Start 1 month trial 6 mg/kg iron supplementation to be taken at breakfast; repeat CBC upon completion

• Parents advised to limit cow's milk consumption to < 20 ounces per day and supplement diet with iron-rich foods

Notes

• Etiology

  • Insufficient iron intake is the most common reason for childhood anemia; affects 3-10% of children

  • No recent viral illness/rash/joint pain decreases likelihood of transient anemia due to Parvovirus B19

• Labs

  • Low MCV + elevated RDW indicates iron deficiency

  • Mentzer index = MCV/RBC count; values > 13 indicate greater likelihood of iron deficiency decreased likelihood of Thalassemia

  • Reticulocyte count <2% indicates that the anemia is not due to a destructive process

  • Normal hemoglobin levels are based on age; hemoglobin increase of >1g/dL one month after supplementation confirms diagnosis

• Iron supplementation in exclusively breastfed infant:

  • <37 WGA: Supplement iron (2 mg/kg/day) from 1 to 12 months of age

  • Full term: Iron supplementation starting at 4 months and continuing until child is eating sufficient iron-containing foods