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The American Academy of Pediatrics recommends universal screening using hemoglobin concentrations and risk factor assessment. Both hemoglobin and hematocrit are late indicators of ID and IDA though. In resource poor countries, clinical examination is recommended. Hemoglobin or hematocrit in intermediate or adequate resourced countries are tests that are recommended. The World Health Organization has recommendations for assessing iron status based on resource availability in the country (see Table 5 of the first reference below). When arbitrary statistical methods are applied to a population (often 2 standards deviations below the normative value) there will be a number of healthy individuals who will be falsely determined to be ID or have IDA.įor a review of the potential side effects of iron therapy click here.įor a review of iron deficiency anemia and lead poisoning, click here.įor a review of non-correcting causes of anemia, click here. The use of multiple tests only partially overcomes the limitation of a single test… and is not an option in resource-poor settings.” The results’ variation in many of the tests used is relatively large including hemoglobin and hematocrit. Unfortunately, however, there is no single standard test to assess iron deficiency without anaemia. Infectious diseases such as malaria or inherited conditions that affect red cell production such as alpha- or beta-thalassemia also cause anemia.Īccording to the World Health Organization, “Iron status can be determined by several well-established tests in addition to measurement of haemoglobin or haematocrit. Other common causes include vitamin A deficiency, folic acid, Vitamin B12 and riboflavin deficiencies. Iron deficiency is not the only cause of anemia. ID and IDA are common in every country in the world and are known to cause impaired motor and cognitive development as well as impairing physical growth. IDA responds to treatment with iron supplementation with at least 10 g/l in hemoglobin or 3% in hematocrit after 1 or 2 months of supplementation. The second is iron deficient erythropoiesis which is a low iron supply but with no anemia and the third stage is iron deficiency anemia (IDA) where the hemoglobin concentration falls below the normal threshold for age and sex. Iron deficiency (ID) is absence of measurable iron stores and is the first stage. There are 3 stages of insufficient iron in the body which form a continuum. Iron is an essential nutrient needed for oxygen transport, storage and utilization. During the conversation, one asked the other, “Which is more accurate, the hemoglobin or the hematocrit?” Both of them did not know the answer to the specific question. A discussion about when to begin empiric iron therapy and how much iron to treat with occurred with both pediatricians discussing the merits of different options. The patient was seen back 6 weeks later by another pediatrician in the practice who obtained additional laboratories including a complete blood count and iron studies which were consistent with iron deficiency anemia. The pediatrician decided to treat her with iron because of the low hematocrit despite the normal hemoglobin because of her social risk factors for iron deficiency anemia. Her screening laboratories showed a normal lead test, and a hemoglobin of 11.0 g/dl and hematocrit of 31%. The family received assistance through federal food programs. She was drinking 16 ounces of whole milk/day and eating table foods. A 14-month-old female came to clinic for her health supervision visit and was found to be healthy and developmentally appropriate.