Anemia screening for pediatrics

It is recommended to universally screen rather than selective screening for patients with risk factors.

When to screen?

All children should be screened once at age 9-12 months of age. However, if the patient is fed an iron-fortified formula, you can delay the screening until 15-18 months of age. It can be helpful to check the iron after the transition from formula to cow's milk. 

Children at high risk for anemia

• excessive cow's milk intake 
• premature infants 

Repeat screening recommendations

• May consider screen again age 15-18 months for high risk children 
• repeat screening at 15-18 months of age and again 2-5 years old for children with special health needs (chronic infection, inflammatory disorder, chronic GI dysfunction, restricted diets, dietary risk factors for IDA)

Anemia thresholds for hgb levels by age 

• 6 months to <5 years – 11 g/dL

• 5 to <12 years – 11.5 g/dL

• 12 to <15 years – 12 g/dL

Method 

• Typically order a CBC. In settings where full CBC cannot be performed, you can order Hgb alone. 
• Can also be a good idea to check ferritin with the CBC or Hgb because it can catch children who are iron deficient but not yet anemic. 

What to do if Hgb is low?

• Focused history. Consider diet (excessive cow's milk or breast feeding w/o iron supplement), lead exposure, underlying medical problem (ex. GI disorder, malabsorption, blood disorder), family hx of anemia 
• Typical presentation of IDA: <3 years old, no evidence of lead toxicity, dietary risk factor for IDA, otherwise healthy patient. 
• First, confirm with a repeat CBC- if normal, could be false positive so routinely monitor. If it is not typical for IDA, do a full evaluation to find cause of anemia. If it is consistent with IDA, trial iron therapy (3 mg/kd/day) and dietary counseling. 
• With iron therapy trial, Hbg should rise >1 g in 4 weeks. If it does, continue iron supplement for 1-2 months after CBC normalizes and continue dietary education. If it does not rise appropriately, do a full evaluation to find cause.

   

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