Iron Deficiency Recommendations/Prevention/Screening

Question 1

Definition of Anemia?

Answer 1

Hgb that is 2 SDs below mean Hgb concentration for normal population of same gender/Age

Question 2

Anemia is defined as a Hgb concentration of less than ___ g/dL for both male and female children age 1-3 yo.

Answer 2

11.0

Question 3

What is the storage form of iron?

Answer 3

Serum Ferritin

Question 4

When does a term newborn baby receive most of their iron in utero?

Answer 4

Third Trimester

Question 5

What is the estimated daily iron requirement for preterm infants?

Answer 5

2-4 mg/kg/day PO

Question 6

What is the estimated daily iron intake for term infants age 0-6 months who are exclusively breastfed?

Answer 6

0.27 mg/day

Question 7

What is the recommended dietary allowance of iron for term infants age 7-12 months?

Answer 7

11 mg/day

Question 8

What is the recommended dietary allowance of iron for term toddlers aged 1-3 years?

Answer 8

7 mg/day

Question 9

What mineral does IDA increase intestinal absorption of?

Answer 9

Lead

Question 10

How does IDA affect chelation therapy in patients with concomitant lead poisoning?

Answer 10

IDA decreases effectiveness of chelators

• giving supplemental iron helps increase effectiveness of chelators

Question 11

What effect does supplemental iron affect patients with IDA and concomitant lead poisoning when chelation therapy is not occuring?

Answer 11

it will increase blood lead concentrations and decrease basal lead excretion

Question 12

What three lab findings provide the most information about iron status?

Answer 12

1. Serum ferritin concentration
2. reticulocyte hemoglobin concentration (CHr)
3. Transferrin Receptor 1 (TfR1) concentration

Question 13

1 microgram/L of transferritin accounts for what amount of available storage iron?

Answer 13

8-10 mg

Question 14

What is the suggested cutoff value of SF in pediatric patients? What must be checked when checking SF to rule out inflammation?

Answer 14

Cutoff: 10 micrograms/L

• check CRP = inc. CRP means inflammation (SR is acute phase reactant)

Question 15

What lab value is the strongest predictor of Iron Deficiency in children?

Answer 15

Reticulocyte Hgb Concentration (CHr)

Question 16

To establish a diagnosis of IDA, what three tests must be obtained?

Answer 16

1. Hgb < 11.0 g/dL

AND

2. SF + CRP levels

OR

3. CHr concentration

Question 17

Using iron supplementation to diagnose IDA, what amount of iron increase in 1 month signifies likely IDA?

Answer 17

1 g/dL increase over 1 month

Question 18

A breastfeeding preterm infant (< 37 weeks gestation) should receive what amount of iron supplementation and when?

Answer 18

2 mg/kg/day

starting at 1 month and lasting through 12 months of age

Question 19

What is the AAPs recommendation on exclusive breastfeeding length?

Why do they recommend this, in the context of IDA?

Answer 19

minimum of 4 months but preferably 6 months

• low iron values in breastmilk, increased risk of IDA by 9 months of age if exclusively breastfed past 6 months

Question 20

Exclusively breastfed term infants should receive how much iron supplementation and for how long?

Answer 20

1 mg/kg/day starting at 4 months until appropriate iron-containing foods have been introduced

Question 21

What is the iron requirement for toddlers (1-3 yo)?

Answer 21

7 mg/day

Question 22

What affect does Vitamin C (ascorbic acid) have on iron absorption?

Answer 22

INCREASES iron absorption

Question 23

When should universal screening for anemia take place in children?

Answer 23

at 1 year of age

Question 24

How long do term, healthy infants iron stores typically last for?

Answer 24

4 months

Question 25

How much iron is typically found in formula?

Answer 25

10-12 mg/L

Question 26

Toddlers not receiving appropriate iron intake can take what form of iron supplement?

Answer 26

LIQUID –> chewable tablets not recommended till >3 years old