Iron Deficiency : Part 10

by CDC

(Page 10 of 11)

Consider anemia screening before age 6 months for preterm infants and low-birthweight infants who are not fed iron-fortified infant formula.

Annually assess children aged 2-5 years for risk factors for iron-deficiency anemia (e.g., a low-iron diet, limited access to food because of poverty or neglect, or special health-care needs). Screen these children if they have any of these risk factors.

At ages 9-12 months and 6 months later (at ages 15-18 months), assess infants and young children for risk factors for anemia.

Screen the following children:

• Preterm or low-birthweight infants
• Infants fed a diet of non-iron-fortified infant formula for greater than 2 months
• Infants introduced to cow's milk before age 12 months
• Breast-fed infants who do not consume a diet adequate in iron after age 6 months (i.e., who receive insufficient iron from supplementary foods)
• Children who consume greater than 24 oz daily of cow's milk
• Children who have special health-care needs (e.g., children who use medications that interfere with iron absorption and children who have chronic infection, inflammatory disorders, restricted diets, or extensive blood loss from a wound, an accident, or surgery).

Diagnosis and Treatment

Check a positive anemia screening result by performing a repeat Hb concentration or Hct test. If the tests agree and the child is not ill, a presumptive diagnosis of iron-deficiency anemia can be made and treatment begun.

Treat presumptive iron-deficiency anemia by prescribing 3 mg/kg per day of iron drops to be administered between meals. Counsel the parents or guardians about adequate diet to correct the underlying problem of low iron intake.

Repeat the anemia screening in 4 weeks. An increase in Hb concentration of greater than or equal to 1 g/dL or in Hct of greater than or equal to 3% confirms the diagnosis of iron-deficiency anemia. If iron-deficiency anemia is confirmed, reinforce dietary counseling, continue iron treatment for 2 more months, then recheck Hb concentration or Hct. Reassess Hb concentration or Hct approximately 6 months after successful treatment is completed.

If after 4 weeks the anemia does not respond to iron treatment despite compliance with the iron supplementation regimen and the absence of acute illness, further evaluate the anemia by using other laboratory tests, including MCV, RDW, and serum ferritin concentration. For example, a serum ferritin concentration of less than or equal to 15 ug/L confirms iron deficiency, and a concentration of greater than 15 ug/L suggests that iron deficiency is not the cause of the anemia.

School-Age Children (Persons Aged 5- less than 12 Years) and Adolescent Boys (Males Aged 12- less than 18 Years)

Among school-age children and adolescent boys, only those who have a history of iron-deficiency anemia, special health-care needs, or low iron intake should be screened for anemia. Age-specific anemia criteria should be used. Treatment for iron-deficiency anemia includes one 60-mg iron tablet each day for school-age children and two 60-mg iron tablets each day for adolescent boys and counseling about dietary intake of iron. Follow-up and laboratory evaluation are the same for school-age children and adolescent boys as they are for infants and preschool children.

Adolescent Girls (Females 12- less than 18 Years) and Nonpregnant Women of Childbearing Age

Primary prevention of iron deficiency for adolescent girls and nonpregnant women of childbearing age is through diet. Information about healthy diets, including good sources of iron, is available in Nutrition and Your Health: Dietary Guidelines for Americans. Screening for, diagnosing, and treating iron-deficiency anemia are secondary prevention approaches. Age-specific anemia criteria should be used during screening.

Primary Prevention

Most adolescent girls and women do not require iron supplements, but encourage them to eat iron-rich foods and foods that enhance iron absorption. Women who have low-iron diets are at additional risk for iron-deficiency anemia; guide these women in optimizing their dietary iron intake.

Secondary Prevention

Screening

Starting in adolescence, screen all nonpregnant women for anemia every 5-10 years throughout their childbearing years during routine health examinations.

Annually screen for anemia women having risk factors for iron deficiency (e.g., extensive menstrual or other blood loss, low iron intake, or a previous diagnosis of iron-deficiency anemia).

Diagnosis and Treatment

Confirm a positive anemia screening result by performing a repeat Hb concentration or Hct test. If the adolescent girl or woman is not ill, a presumptive diagnosis of iron-deficiency anemia can be made and treatment begun.

Treat adolescent girls and women who have anemia by prescribing an oral dose of 60-120 mg/day of iron. Counsel these patients about correcting iron deficiency through diet.

About the Author

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The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.