Iron Deficiency and Iron Deficiency Anemia
Commentary by Jason Payne, MD, MSPH
Published February 2024
Anemia is a condition in which the hemoglobin concentration or red blood cell numbers are lower than normal and are inadequate to meet the demands of the body. This widespread condition affects one-third of the global population, negatively affecting morbidity and mortality across all ages, particularly women and children. Not only is anemia associated with poor birth outcomes such as low birth weight, but its neurocognitive effects are also broader, including decreased work productivity in adults and impaired cognitive and behavioral development in children. As pediatricians, anemia (particularly iron deficiency anemia) is considered a bread-and-butter diagnosis every pediatrician should be familiar with recognizing, diagnosing, and treating. This module will outline the important features every pediatrician should be familiar with when diagnosing anemia and iron deficiency within the first 1,000 days of life.
Keywords: nutrient deficiency; diet; vitamin c; anemia of prematurity; food insecurity
1. Overview
- 1a. Definitions
- 1b. Prevalence
- 1c. Nutritional Requirements for Iron
- 1d. Daily Recommended Intake of Dietary Iron
- 1e. Risk Factors for Iron Deficiency and Presentation
2. Anemia of Prematurity
3. Diagnosis
4. Treatment and Monitoring
- 4a. Treatment
- 4b. Social Determinants of Health
- 4c. Consultations to Consider
- 4d. Follow-Up and Monitoring
5. Anticipatory Guidance
6. Clinical Pearls
7. Additional Resources
8. References
Introduction
1a. Definitions
Anemia is defined as a decreased hemoglobin (Hb) concentration 2 standard deviations below the mean for healthy, age- and gender-matched individuals as defined by the World Health Organization. The WHO uses the following cut-offs to define anemia:
● Children 6 months to <5 years: 11 g/dL
● Children 5 to <12 years: 11.5 g/dL
● Children 12 to <15 years: 12 g/dL
● Adolescent and young adult (AYA) women ≥15 years: 12 g/dL
AYA men ≥15 years: 13 g/dL
Previous reports have described lower mean Hb levels among Black Americans, however, these levels are thought to reflect underlying health disparities related to social determinants of health. When assessing for anemia and iron deficiency (ID), it is recommended to employ uniform Hb and hematocrit (Hct) thresholds across all ethnic and racial populations. Caution should be exercised to avoid presuming that a marginally lower value within a Black individual is within the “normal range.”
