Occurrence and Detection of Iron-Deficiency Anemia in Infants and Toddlers

1. Richard Bamberg[⇑][1] 1. is professor and chairman of the Department of Clinical Laboratory Science at East Carolina University, Greenville NC 1. Address for correspondence: Richard Bamberg PhD MT(ASCP)SH CLDir CHES, professor and chairman, Department of Clinical Laboratory Science, College of Allied Health Sciences, East Carolina University, Greenville, NC 27858-4353. (252)744-6060, (252)744-6068 (fax). bambergw{at}ecu.edu. 1. Recognize infant and toddler populations vulnerable to developing iron deficiency. 2. Describe characteristic laboratory findings evaluating infant erythropoiesis. 3. Identify variations in iron requirements from birth to age three years. 4. Describe specific laboratory tests and expected results to detect iron deficiency anemia. 5. Distinguish the sensitivity and specificity of the specific tests to detect iron deficiency anemia. 6. Recognize laboratory tests that detect iron deficiency before frank anemia develops. 7. Describe the main limitations of the reticulocyte hemoglobin content assay. Infants and toddlers are particularly vulnerable to developing iron deficiency, which can cause irreversible deficits in neurodevelopment. Children at highest risk include premature and low birth weight infants, those who are fed cow's milk rather than breast milk or formula prior to age one, and those who drink large amounts of cow's milk as toddlers. It is important to detect iron deficiency before it becomes frank anemia through the use of appropriate laboratory tests. Hemoglobin or hematocrit testing, at around age one, has been the usual screening test. These tests, however, do not become abnormally low until frank anemia has developed. Over the past decade, research has shown the assay for reticulocyte hemoglobin content to be a much earlier indicator of iron deficiency. This article provides an overview of the epidemiology, occurrence, and detection of iron deficiency and iron deficiency anemia in young children as well as a comparison of the utility of various laboratory tests. Infants and toddlers are particularly vulnerable to the effects of anemia due to the rapid growth and development of the brain and the rest of the body from birth to age three. Pre-term and/or low birth weight infants are even more vulnerable. Although it is more common in developing countries due to nutritional deficiencies and chronic blood loss from parasitic infections,1 iron-deficiency anemia (IDA) is the most prevalent anemia found in infants, toddlers and child-bearing age females in the United States.2 Therefore, it is important to detect a state of iron deficiency in these… ABBREVIATIONS : CHr = hemoglobin content in reticulocytes; dL = deciliter; FEP/ZPP = free/zinc erythropoietic protoporphyrin; fL = femtoliters; g = gram; ID = iron deficiency; IDA = iron-deficiency anemia; L = liter; MCH = mean cell hemoglobin; MCV = mean corpuscular volume; mg = milligrams; ng = nanograms; NRBC = nucleated red blood cells; oz = ounces; pg = picograms; RDW = red blood cell distribution width; Ret He = reticulocyte hemoglobin; SF = serum ferritin; sTfR = serum transferrin receptor; TIBC = total iron binding capacity; TS = transferrin saturation; ug = micrograms. 1. Recognize infant and toddler populations vulnerable to developing iron deficiency. 2. Describe characteristic laboratory findings evaluating infant erythropoiesis. 3. Identify variations in iron requirements from birth to age three years. 4. Describe specific laboratory tests and expected results to detect iron deficiency anemia. 5. Distinguish the sensitivity and specificity of the specific tests to detect iron deficiency anemia. 6. Recognize laboratory tests that detect iron deficiency before frank anemia develops. 7. Describe the main limitations of the reticulocyte hemoglobin content assay. [1]: #corresp-1