From the Guidelines
Low hemoglobin and hematocrit in children, commonly indicating anemia, requires prompt evaluation and treatment based on the underlying cause, with the most recent and highest quality study suggesting that iron deficiency anemia can be diagnosed and treated with oral iron supplementation at 3-6 mg/kg/day of elemental iron, as stated in the 2021 study 1.
Evaluation and Treatment
The evaluation should include a complete blood count, iron studies, and possibly additional testing based on clinical presentation to identify causes such as nutritional deficiencies, chronic disease, hemoglobinopathies, or blood loss.
- The most common treatment for iron deficiency anemia is oral iron supplementation at 3-6 mg/kg/day of elemental iron, divided into 1-3 doses, given between meals with vitamin C to enhance absorption, as recommended by the 2021 study 1.
- Treatment typically continues for 3 months after hemoglobin normalizes to replenish iron stores.
- For severe anemia (hemoglobin <7 g/dL) or symptomatic children, hospital admission and possible blood transfusion may be necessary.
Dietary Modifications and Preventive Measures
Dietary modifications should include iron-rich foods like lean meats, fortified cereals, beans, and leafy greens.
- Parents should monitor for improvement in symptoms like fatigue, pallor, and irritability.
- Preventive measures include iron-fortified formula for infants not exclusively breastfed, iron-rich complementary foods after 6 months, and limiting cow's milk to less than 24 ounces daily in toddlers to prevent iron deficiency, as suggested by the 1998 study 1.
Diagnosis and Laboratory Assessment
The diagnosis of iron deficiency anemia can be made if hemoglobin concentration or hematocrit increases after a course of therapeutic iron supplementation, as stated in the 1998 study 1.
- Laboratory assessment of iron status relies on a combination of biochemical indicators, especially in case of a combination of iron deficiency and inflammation, as discussed in the 2021 study 1.
- The combined assessment and interpretation of ferritin and transferrin saturation is useful in the diagnosis of absolute and functional iron deficiency.
From the Research
Low Hemoglobin and Hematocrit in Children
- Low hemoglobin and hematocrit levels in children can be indicative of anemia, which may be caused by iron deficiency 2, 3.
- Iron deficiency anemia is a common condition that can cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating 2.
- The diagnosis of iron deficiency anemia can be made by measuring serum ferritin and/or transferrin saturation levels 2, 3.
- A complete blood count (CBC) with differential count and reticulocyte count can help narrow the differential diagnosis and tailor the subsequent evaluation of low hemoglobin and hematocrit levels in children 4.
- It is recommended that every child have a baseline hematology evaluation with hemoglobin and hematocrit levels starting at age 12 months, or younger if clinically indicated 4.
Risk Factors and Diagnosis
- Risk factors for iron deficiency anemia in children include inadequate dietary iron intake, impaired iron absorption, and chronic inflammatory conditions 2.
- The most efficient test for the diagnosis of iron deficiency is the serum ferritin level 3.
- Oral iron replacement is typically the first-line therapy for iron deficiency anemia, while intravenous iron may be indicated for patients with oral iron intolerance or impaired absorption 2.
Importance of Early Detection
- Early detection and treatment of low hemoglobin and hematocrit levels in children are crucial to prevent long-term complications and improve outcomes 4.
- A step-by-step approach to interpreting complete blood count results can help clinicians diagnose and interpret common blood disorders seen in pediatric patients 4.