What is the recommended treatment for a 15-month-old child with iron deficiency anemia, as indicated by low ferritin level, total iron, and iron saturation?

Treatment for Iron Deficiency in a 15-Month-Old Child

The 15-month-old child with a ferritin of 20 μg/L should be treated with oral iron supplementation at a dose of 3 mg/kg/day of elemental iron administered between meals for at least 3 months, with follow-up hemoglobin testing in 4 weeks to confirm response to treatment. 1

Laboratory Interpretation

The child's laboratory values indicate iron deficiency:

• Ferritin: 20 μg/L (low, indicating depleted iron stores)
• Total iron: 169 (relatively low)
• Iron binding capacity: 494 (elevated)
• Iron saturation: 34% (within normal range, but can be misleading)
• Hematocrit: 43.1% (normal)
• MCV: 88.0 (normal)
• Platelets: 433 (slightly elevated)

While the child has normal hemoglobin/hematocrit values, the low ferritin indicates iron depletion that requires treatment to prevent progression to iron deficiency anemia.

Treatment Protocol

Oral Iron Therapy

• Dosage: 3 mg/kg/day of elemental iron drops 1
• Administration: Give between meals to maximize absorption
• Duration: Minimum 3 months (continue for 2 months after normalization of hemoglobin)
• Form: Iron drops are preferred for this age group

Dietary Recommendations

• Limit cow's milk intake to no more than 24 oz per day 1, 2
• Encourage iron-rich foods:
  • Iron-fortified cereals
  • Pureed meats
  • Iron-rich vegetables
• Include vitamin C-rich foods with meals to enhance iron absorption 1

Monitoring Response

1. Follow-up testing: Check hemoglobin concentration in 4 weeks 1
2. Expected response: An increase in hemoglobin concentration of ≥1 g/dL confirms the diagnosis of iron deficiency anemia 1
3. If response is inadequate:
   • Evaluate compliance with iron therapy
   • Consider additional testing including MCV, RDW, and repeat serum ferritin 1
   • Assess for other potential micronutrient deficiencies that may impair response 3

Important Considerations

Potential Pitfalls

• Excessive cow's milk intake is a common cause of iron deficiency in this age group 2
• Poor compliance with iron therapy due to gastrointestinal side effects
• Multiple micronutrient deficiencies may impair response to iron supplementation 3
• Mean Cell Hemoglobin (MCH) is a more reliable marker than Mean Cell Volume (MCV) for detecting iron deficiency 2

When to Consider Alternative Approaches

• If no response to oral iron after 4 weeks despite compliance
• If gastrointestinal intolerance to oral iron occurs
• In cases of severe anemia or malabsorption (not applicable in this case)

Prevention of Recurrence

After successful treatment:

• Continue to limit cow's milk to ≤24 oz daily
• Maintain adequate dietary iron intake
• Consider screening again at 24 months if risk factors persist
• Reassess hemoglobin concentration approximately 6 months after successful treatment 1

This approach prioritizes early intervention to prevent potential developmental delays and cognitive impairment that can occur with iron deficiency, even before the development of anemia 2.