Infants
True or False: Iron deficiency is associated with poorer performance with object permanence and short term memory in infancy, compared with iron sufficient infants.
TRUE
Which gender is more commonly affected?
Female
What is the RDW in iron deficiency anemia (high/low/normal)?
High
Which vitamin enhances iron absorption?
Vitamin C - and an acidic environment
When do you first screen for anemia?
9-12mo
Which allows for better absorption of iron, Cow’s milk of human’s milk (breastmilk)?
HUMAN
Human milk has 50% absorption, while cow’s milk has 10%. Formulas are fortified with iron.
Name two risk factors for iron deficiency anemia in adolescence
Rapid growth
Blood loss (menstruation, hematuria, GI blood loss, H pylori infection).
You are rechecking a CBC in a child with suspected Fe deficiency (microcytic anemia on last CBC). You have been treating with iron supplementation for the last month. A CBC with an increase in hgb of ___ g/dL is confirmatory of the diagnosis of Fe deficiency anemia.
1 g/dL
What time of day should parents give iron supplementation in order to minimize side effects?
After meals - and giving with acidic beverage may help absorption
Where in the intestine does iron absorption take place?
Duodenum
Do preterm infants have higher requirements for iron supplementation?
Yes
They are more likely to require blood draws early on, and they do not benefit from increased iron absorption from maternal supply that occurs during the third trimester
You should screen for anemia in adolescents with (2)_____
Diet poor in iron
Heavy menses
Symptomatic
Name at least two labs you should get when considering thalassemia as a diagnosis (aside from CBC)?
- LDH
- indirect (unconjugated) bilirubin,
- Haptoglobin
- Coombs testing
Name two side effects of ferrous sulfate.
Constipation
Dark stools
Dental staining
Nausea
Epigastric pain
Name three clinical symptoms of mild Fe deficiency anemia.
-fatigue
-exorcise intolerance
-irritability
-anorexia
When does the physiologic nadir of infancy occur?
6-8 weeks of life
Compared to infants, how quickly do adolescents typically recover their iron stores?
What is one lab value on the CBC that can help differentiate between Fe deficiency anemia and thalassemia minor?
RDW - will be high in Fe deficiency anemia and low in thalassemia minor.
*Interestingly, RDW becomes very elevated during iron replacement (25-30%)
Meitzner index (MCV/RBC count) - >13.5 is suggestive of Fe deficiency anemia, <13.5 is thalassemia.
*Because in thalassemia, RBC production is preserved.
Are there flavored alternatives for the liquid iron supplementation (Fer-in-sol)?
Yes - ex: NovaFerrum
Consumption of greater than ____oz of milk is associated with Fe deficiency anemia?
24oz
Why does the physiologic nadir of infancy occur?
- Erythrypoesis temoporarily stops when respiration starts at birth
- EPO has a shorter half life and larger volume of distribution in newborn
- Fetal RBCs have a shorter half life
What is the dose for iron repletion in adolescents?
60-100mg of elemental iron per day (can be used for anyone >20 kg)
One tablet of Fe sulfate contains 65mg of elemental iron. Can dose 1-2 tablets per day.
Combination iron/vitamin C tablets are available
In Fe deficiency anemia, what is the order in which you see lab value changes of: (1) ferritin, (2) Hgb and (3) MCV?
Ferritin, Hgb and then MCV
Can also see mild to moderate thrombocytosis with Fe deficiency anemia
What is an off label use of Ferrous sulfate in adults?
Restless leg syndrome
Which age group has a higher prevalence of Fe deficiency anemia: one year olds or 3-5 year olds?
One year olds
Data analysis from 2016 showed 14% one year olds had Fe deficiency anemia comapared to 4% of preschool children. And 9% of women 12-19 and 20-49yo.