Management of Anemia in a 15-Year-Old with Hemoglobin 9.8 g/dL
For a 15-year-old with a hemoglobin of 9.8 g/dL, iron deficiency should be presumed and treated with oral iron supplementation at 60-120 mg of elemental iron daily while investigating underlying causes. This approach addresses the most common cause of anemia in this age group while preventing further deterioration in hemoglobin levels.
Diagnosis and Classification
According to WHO criteria, this patient has mild anemia:
- Normal hemoglobin for adolescents 12-15 years: ≥11.5 g/dL 1
- For adolescents >15 years: ≥12.0 g/dL for females and ≥13.0 g/dL for males 2
Initial Evaluation
Laboratory Testing
- Complete blood count with indices
- Iron studies:
- Serum ferritin (primary test for iron deficiency)
- Transferrin saturation
- Total iron binding capacity
- Serum iron
Clinical Assessment
- Evaluate for:
- Menstrual history (if female)
- Dietary habits (inadequate iron intake)
- GI symptoms (potential bleeding)
- Chronic diseases
- Medication use
Treatment Algorithm
Step 1: Initiate Iron Therapy
- Oral iron supplementation: 60-120 mg of elemental iron daily for adolescents 3
- Ferrous sulfate is preferred (approximately 65 mg elemental iron per tablet) 3
- Take on empty stomach with vitamin C (500 mg) to enhance absorption 3
- Avoid tea and coffee within one hour of taking iron supplements 3
Step 2: Dietary Recommendations
- Encourage iron-rich foods
- Limit consumption of foods that inhibit iron absorption
- Ensure adequate intake of vitamin C to enhance iron absorption 3
Step 3: Monitor Response
- Check hemoglobin within 4 weeks of starting therapy
- Expect an increase of at least 1 g/dL within 2 weeks of supplementation 3
- Continue iron therapy for 3 months after normalization of hemoglobin to replenish iron stores 3
Step 4: Investigate Underlying Causes
- If no response to iron therapy after 4 weeks despite compliance, further evaluation is needed 1
- Consider referral to gastroenterology if GI symptoms or suspected blood loss
Special Considerations
When to Consider IV Iron
IV iron is generally not first-line for adolescents but may be considered if:
- Intolerance to oral iron
- Failure to respond to oral iron
- Malabsorption disorders
- Need for rapid correction of anemia 3
When to Consider Transfusion
Transfusion is rarely indicated for stable patients with hemoglobin >7.5 g/dL unless:
- Hemodynamic instability
- Symptomatic anemia not responding to other measures
- Acute blood loss 1
Common Pitfalls to Avoid
Failing to identify the underlying cause: Iron deficiency anemia requires investigation of the source of iron loss or inadequate intake.
Inadequate duration of therapy: Continuing iron supplementation for 3 months after hemoglobin normalization is essential to replenish iron stores.
Poor adherence due to side effects: Consider alternate-day dosing if daily dosing causes gastrointestinal side effects 3.
Overlooking functional iron deficiency: Even with normal ferritin, transferrin saturation <20% may indicate functional iron deficiency 3.
Missing non-iron deficiency causes: While iron deficiency is most common, consider other etiologies if response to iron is inadequate.
By following this approach, the majority of adolescents with mild anemia will show improvement in hemoglobin levels while the underlying cause is being addressed.