Treatment of Iron Deficiency Anemia in an 11-Year-Old
For an 11-year-old with iron deficiency anemia, treat with oral ferrous sulfate at 3 mg/kg per day of elemental iron administered between meals, combined with dietary counseling to address underlying low iron intake. 1, 2
Confirming the Diagnosis
Before initiating treatment, confirm iron deficiency anemia with:
- Low serum ferritin concentration (≤15 μg/L) 1, 2
- Complete blood count showing low hemoglobin with microcytic, hypochromic red cells 1
- Consider checking serum iron, total iron-binding capacity, and transferrin saturation 1
Treatment Protocol
Oral Iron Supplementation
Use ferrous sulfate as the preferred iron preparation because it is the most cost-effective option and provides known amounts of elemental iron. 2, 3 A 2017 randomized clinical trial demonstrated that ferrous sulfate is superior to iron polysaccharide complex, resulting in a 1.0 g/dL greater increase in hemoglobin at 12 weeks (P < .001) and higher rates of complete resolution of anemia (29% vs 6%, P = .04). 3
Dosing specifics:
- Administer 3 mg/kg per day of elemental iron 1, 2
- Give between meals to maximize absorption, as food can reduce iron absorption by up to 50% 2
- Avoid administration within 2 hours before or 1 hour after meals 2
- Each ferrous sulfate 324 mg tablet contains 65 mg of elemental iron 4
Duration of therapy:
- Continue treatment for at least 2-3 months after hemoglobin normalization to replenish iron stores 1, 2
- Monitor response with repeat hemoglobin/hematocrit at 4 weeks 1, 2
- An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms adequate response 1, 2
- Reassess hemoglobin approximately 6 months after successful treatment 1
Dietary Modifications
Counsel parents and patient on dietary changes:
- Limit milk consumption to no more than 24 oz daily, as excessive milk intake displaces iron-rich foods and can cause occult blood loss 1, 2
- Encourage iron-rich foods (red meat, poultry, fish, beans, fortified cereals) 1, 2
- Include vitamin C-rich foods with meals to improve iron absorption 1, 2
Common Pitfalls to Avoid
Do not use iron polysaccharide complex: Despite being marketed as better tolerated, it is more expensive and less effective than ferrous sulfate. 2, 3
Do not add ascorbic acid supplements: They do not improve ferrous iron absorption. 2
Do not ignore adherence issues: If the patient has difficulty tolerating oral iron due to gastrointestinal side effects, start with smaller, more frequent doses and gradually increase to the target dose rather than switching formulations. 2
Do not forget to investigate the underlying cause: For an 11-year-old, consider inadequate dietary intake, rapid growth spurts, menstrual blood loss (in girls), and malabsorption. 5, 6 Unlike adult men or postmenopausal women, gastrointestinal blood loss from serious pathology is uncommon in this age group. 5
Management of Non-Response
If anemia persists after 4 weeks of iron supplementation despite confirmed compliance:
- Evaluate for other contributing factors such as copper deficiency, ceruloplasmin deficiency, or vitamin B12 deficiency 1
- Consider recombinant human erythropoietin therapy in refractory cases, though this is rarely necessary 1
- Reassess the diagnosis and consider alternative causes of microcytic anemia 1