Screening for Iron Deficiency

Ann Chen Wu; Leann Lesperance; Henry Bernstein

doi:10.1542/pir.23-5-171

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Ann Chen Wu, MD*
Leann Lesperance, MD, PhD*
Henry Bernstein, DO*†

^*Pediatric Health Associates, Hunnewell Ground Children’s Hospital
^†Associate Professor of Pediatrics, Harvard Medical School, Boston, MA

Objectives

After completing this article, readers should be able to:

Determine the most common cause of iron deficiency in the United States.
Describe the pathogenesis of iron deficiency.
List populations at high risk for iron deficiency.
Outline the common signs and symptoms of iron deficiency.
Specify the American Academy of Pediatrics recommendations for screening for iron deficiency.

In the March and April issues of Pediatrics in Review, we published a two-part article on managing anemia in a pediatric office practice. This article expands on the various tests for iron deficiency, including some relatively new ones. These articles should be read as complementary.—RJH

Introduction

Iron deficiency is the most common nutritional deficiency in the world, responsible for a staggering amount of ill health, lost productivity, and premature death. Although its prevalence in the United States has declined since the late 1960s, iron deficiency with or without anemia still is seen frequently in infants, toddlers, adolescent females, and women of childbearing age. In fact, iron deficiency anemia remains the most common hematologic disease of infants and children.

Definitions

Anemia is defined as a low hemoglobin (Hgb) concentration or red blood cell (RBC) mass compared with age-specific norms. Anemia may be caused by decreased RBC production, increased RBC destruction, or blood loss. Based on the size of the RBC, hematologists categorize anemia as macrocytic, normocytic, or microcytic.

Iron is found in different compartments within the body. Total body iron (measured by ferritin), transport iron (measured by transferrin saturation), serum iron, and other hematologic and biochemical markers are used to describe the degrees of iron deficiency. Iron depletion refers to the earliest stage of diminishing iron stores in the setting of insufficient iron supply. Iron deficiency (without anemia) develops as these iron stores are depleted further and begin to impair Hgb synthesis. Finally, iron deficiency anemia results …