- The goal of this study was to assess the adequacy of hemoglobin screening
for iron deficiency, a condition which, if left untreated, could result
in poor cognitive outcomes.
- The study stresses that by using a hemoglobin screen, many actual
iron deficient children will be missed, and many anemic children will
be treated inappropriately.
- It was unclear whether all children in this age group evaluated by
the NHANES study had this same complete laboratory investigation, or
if this was just a subset of a much larger group.
- The article did not indicate if those performing the study were unaware
of the patients' iron deficiency status when analyzing the hemoglobin
levels; therefore, diagnostic uncertainty was potentially not experienced.
- Other studies confirm the findings in this study; however, most of
the others do not use the same criteria for iron deficiency as is stipulated
in this analysis.
- The study also stresses primary prevention of iron deficiency with
fortified formula and cereal; however, this is only applicable mainly
to the developed world.
- Treatment for iron deficiency is fairly benign and can possibly prevent
an untoward outcome, but screening also involves lab draws and possible
misdiagnosis, both of which are unsettling to children and parents.
- A study by Ullrich et al. recently indicated that screening for iron
deficiency with reticulocyte hemoglobin content (CHr) is more effective
than Hgb; however, the study was much smaller (202 patients), and was
an initial study examining levels at which CHr predicts iron deficiency.2
Further evaluation of this is warranted.
KC. Anemia is a poor predictor of iron deficiency among toddlers in
the United States: for heme the bell tolls. Pediatrics 2005;115:315-20.
C, Wu A, Armsby C, et al. Screening healthy infants for iron deficiency
using reticulocyte hemoglobin content. JAMA 2005;294:924-30.