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Iron Deficiency and Iron-deficiency Anemia in Toddlers Ages 18 to 36 Months: A Prospective Study
Carina Levin1, Shira Harpaz, Isam Muklashi
1*Pediatric Department B and Pediatric Hematology Unit, Emek Medical Center, Afula ‡Clalit Health Services, Northern District †The Ruth and Baruch Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Iron deficiency (ID) and iron deficiency anemia (IDA) are common in toddlers, even after iron supplementation. Early detection and continued monitoring are crucial for neurodevelopment.
Area of Science:
- Pediatrics
- Nutritional Science
- Hematology
Background:
- Iron deficiency (ID) is the most common cause of anemia in young children.
- ID can negatively impact long-term neurodevelopment and behavior.
- Prevalence of ID and IDA in toddlers requires further investigation.
Purpose of the Study:
- To evaluate the prevalence of ID and iron deficiency anemia (IDA) in healthy toddlers aged 18-36 months in Northern Israel.
- To assess risk factors associated with ID and IDA.
- To compare iron status with first-year screening results.
Main Methods:
- Prospective evaluation of 256 healthy children aged 18-36 months.
- Complete blood count and ferritin levels were measured.
- Risk factors were assessed, and hemoglobin (Hgb) was compared with first-year screening.
Main Results:
- Prevalence: 5.8% IDA, 16.3% ID without anemia, 9.6% anemia with normal ferritin.
- In infants nonanemic at 1 year (n=156), 19.9% had ID/IDA, and 12.8% developed anemia by study evaluation.
- ID and IDA remained prevalent and could develop during the second year of life, despite supplementation and normal first-year screening.
Conclusions:
- Iron deficiency and iron deficiency anemia are prevalent in toddlers, even with iron supplementation and normal initial screening.
- A significant subset of children may develop ID/IDA during their second year of life.
- Continued monitoring and consideration of iron supplementation are essential for this vulnerable population.
Abstract:
In young children, iron deficiency (ID)-the most common cause of anemia-may adversely affect long-term neurodevelopment and behavior. We prospectively evaluated the prevalence of ID and iron deficiency anemia (IDA) in 256 healthy 18- to 36-month-old children in Northern Israel. Complete blood count and ferritin evaluation were performed, and risk factors were assessed. Hemoglobin (Hgb) was compared with first-year routine screening. Complete data were obtained from 208 children: 56.2% were boys; the mean age was 26.1±5.27 months. A prevalence of 5.8% IDA, 16.3% ID without anemia, 9.6% anemia with normal ferritin, and 68.3% normal Hgb and ferritin was found. In nonanemic infants at 1 year of age (n=156), ID/IDA was found in 19.9%, and 12.8% became anemic at study evaluation. Despite iron supplementation in the first year, and normal Hgb at first-year screening, ID and IDA were still prevalent, and might develop during the second year of life. Recognition of this child subset and consideration of iron supplementation are mandatory.
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Disorders of Erythrocytes
Erythrocyte disorders can be broadly categorized into two main types: anemic and polycythemic conditions.
A low oxygen-carrying capacity of the blood due to the loss, lower production, or destruction of erythrocytes is termed anemia. Hemorrhagic anemia, for example, occurs when bleeding from an external wound or internal ulcer reduces erythrocyte counts.
On the other...

