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Published on: September 6, 2017
Outcome of children identified as anemic by routine screening in an inner-city clinic
D L Bogen1, J P Krause, J R Serwint
1General Academic Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Room G205, Pittsburgh, PA 15213, USA. bogend@chplink.chp.edu
Insights
Routine anemia screening in children using HemoCue and prescribing iron is problematic. High anemia rates and low follow-up challenge this diagnostic approach for iron deficiency anemia (IDA).
Area of Science:
- Pediatric Hematology
- Public Health Screening
Background:
- Routine hemoglobin (Hb) screening in children often leads to iron prescriptions for presumed iron deficiency anemia (IDA).
- This practice is questioned due to declining IDA prevalence and increasing other anemia causes.
Purpose of the Study:
- To evaluate Hb screening for IDA using HemoCue.
- To determine anemia prevalence, iron prescription rates, follow-up frequency, and 6-month outcomes.
Main Methods:
- Retrospective cohort study of 1358 children aged 9-36 months.
- Analysis of outpatient medical records for anemia diagnosis and treatment.
Main Results:
- 25% of children screened had anemia (Hb < 110 g/L).
- 72% of anemic children received iron prescriptions; follow-up rates were low (37-42% at 6 months).
- Similar resolution rates were observed in treated (71%) and untreated (68%) groups.
Conclusions:
- HemoCue screening followed by iron trial is problematic due to high anemia rates, low follow-up, and spontaneous resolution.
- Further research needed on alternative screening methods and improving outcomes in urban children.
Background:
Children found to be anemic on routine screening by HemoCue, a rapid and relatively inexpensive method of screening for hemoglobin (Hb), are often prescribed iron as a diagnostic tool and potential treatment for presumed iron deficiency anemia (IDA). We questioned this approach given the declining prevalence of IDA and the concomitant relative increase in other causes of anemia.
Objective:
To evaluate the practice of Hb screening for IDA by determining the prevalence of anemia by HemoCue; the proportion of anemic patients treated with iron and followed up; the frequency of repeated Hb testing, additional iron studies, and iron prescriptions; and the 6-month outcomes of treated and untreated anemia.
Design:
Retrospective cohort study.
Results:
Of 1358 children aged 9 to 36 months who underwent screening, 343 (25%) had anemia, defined as a Hb level of less than 110 g/L. Outpatient medical records of 334 of the anemic children revealed that 239 (72%) were prescribed iron while 95 (28%) were not prescribed iron at the first visit for anemia. Anemia follow-up rates were low for the prescribed and not prescribed groups: 7% vs 5% returned within 1 month, while 37% vs 42% did not return within 6 months for follow-up. Of the children who were prescribed iron, 107 (71%) of 150 responded to treatment or anemia resolved within 6 months compared with 27 (68%) of 40 not prescribed iron. Children underwent repeated blood testing for measurement of Hb and complete blood cell count, but underwent few iron-specific studies.
Conclusions:
Routine screening for IDA by HemoCue followed by a therapeutic trial of iron was problematic because of a high rate of anemia in this predominantly African American population, low follow-up rates, and a high spontaneous resolution rate. Prospective studies are needed to evaluate other screening methods to differentiate IDA from other forms of anemia and to improve compliance and outcome in inner-city children.
