Treatment of Iron Deficiency Anemia in Children

Diagnosis and Confirmation

The Centers for Disease Control and Prevention (CDC) recommends confirming iron deficiency anemia with low serum ferritin concentration (≤15 μg/L) before initiating treatment. 1
Additional laboratory tests to consider include complete blood count with red cell indices and serum iron, total iron binding capacity, and transferrin saturation. 3
Reticulocyte count should be assessed as a marker of erythropoiesis and response to therapy. 4
Red cell distribution width (RDW) can be used in further evaluation if anemia does not respond to iron treatment. 3

The CDC recommends oral iron supplementation at a dose of 3 mg/kg per day of elemental iron administered between meals for children with iron deficiency anemia. 1
Treatment should continue for at least 2-3 months after hemoglobin normalization to replenish iron stores. 1
Monitor treatment response with repeat hemoglobin/hematocrit in 4 weeks; an increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms diagnosis and adequate response. 1
Reassess hemoglobin concentration or hematocrit approximately 6 months after successful treatment. 1

The CDC recommends counseling parents about adequate diet to correct the underlying problem of low iron intake. 1
Limit milk consumption to no more than 24 oz daily as excessive milk intake can contribute to iron deficiency. 3
Encourage iron-rich foods and vitamin C sources with meals to improve iron absorption. 3

If anemia persists after 4 weeks of iron supplementation despite compliance, recombinant human erythropoietin (EPO) therapy has been reported to be safe and efficacious for treatment of anemia in children with certain conditions. 4
Increased doses of EPO may be required due to urinary losses, and subcutaneous administration might be superior to IV administration. 4
For non-responsive cases, evaluate for other possible contributing factors such as copper deficiency, ceruloplasmin deficiency, or vitamin B12 deficiency. 4

The CDC recommends considering routine screening at regular intervals for children at high risk for iron deficiency anemia. 3