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Screening for Anemia in Children with Down Syndrome
Shruti Mittal1, Andrea D Boan, Silvia Pereira-Smith
1Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Insights
Children with Down syndrome (DS) have a higher prevalence of anemia than the general population. This study supports annual hemoglobin and ferritin screening for children with DS up to age 18.
Area of Science:
- Pediatrics
- Hematology
- Genetics
Background:
- The American Academy of Pediatrics (AAP) recommends annual screening for iron deficiency anemia in children with Down syndrome (DS) aged 1-18 years.
- The evidence supporting this recommendation is limited, necessitating further investigation.
Purpose of the Study:
- To assess the prevalence of anemia in patients with DS aged 1-18 years.
- To provide evidence supporting AAP guidelines for annual hemoglobin and ferritin screening in this population.
Main Methods:
- Retrospective cohort study using electronic health records (EHR) from July 2012 to 2016.
- Inclusion criteria: diagnosis of DS, age 1-18 years, and hemoglobin levels drawn within the study period.
- Statistical analysis included Fisher exact test and chi-squared test.
Main Results:
- A total of 200 patients with DS were analyzed.
- The prevalence of anemia (hemoglobin < 2 SDs for age) was 22.5%, significantly higher than the 3.2% reported in the general population (ages 1-5).
- Among anemic patients, 67.5% had normocytic anemia, 27.5% macrocytic, and 5% microcytic. Only 10% of anemia cases were diagnosed in the EHR.
Conclusions:
- The prevalence of anemia in children with DS is significantly higher than in the general population.
- These findings support the AAP's recommendation for annual screening for anemia in children with DS until age 18.
Objective:
As part of the 2011 American Academy of Pediatrics (AAP) health supervision guidelines for children with Down syndrome (DS), annual screening for iron deficiency anemia is recommended between the ages of 1 and 18 years, but the evidence supporting this recommendation is limited. This study aimed to assess the prevalence of anemia in patients with DS between the ages of 1 and 18 years to provide additional evidence for the AAP 2011 guideline recommendations for annual hemoglobin and ferritin screening in patients with DS.
Methods:
A retrospective cohort study was completed by obtaining data from the electronic health record (EHR) for patients meeting the following inclusion criterion: a diagnosis of DS in patients aged 1 to 18 years seen at our institution with hemoglobin drawn between July 2012 and 2016. Data were analyzed by the Fisher exact test and χ test.
Results:
A total of 200 patients were identified. 22.5% had anemia, defined as a hemoglobin concentration less than 2 SDs for normed age. The National Health and Nutrition Examination Survey (2007-2010) reported prevalence of anemia for children aged 1 to 5 years is 3.2% when compared with 18.7% in our sample. Of the 45 children with anemia, 5% had a microcytic, 67.5% a normocytic, and 27.5% a macrocytic anemia. Only 10 received a diagnosis of anemia in the EHR.
Conclusion:
The prevalence of anemia in this cohort of children with DS is significantly higher than that in the general population, supporting the AAP guidelines for an annual screening until the age of 18 years.
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