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Severe iron deficiency anemia in the paediatric emergency department: A retrospective study
Matthew Speckert1,2, Lana Ramic2, Nicholas Mitsakakis3
1Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Intravenous iron sucrose effectively treats severe iron deficiency anemia in children, offering a safe alternative to blood transfusions. This approach rapidly improves hemoglobin levels without significant adverse events or emergency department returns.
Area of Science:
- Pediatric Hematology
- Emergency Medicine
- Anemia Management
Background:
- Severe iron deficiency anemia (IDA) in children often leads to transfusion recommendations.
- Intravenous iron sucrose (IV IS) presents a potential alternative, but data in pediatric emergency departments (EDs) is limited.
Purpose of the Study:
- To evaluate the efficacy and safety of IV iron sucrose in managing severe IDA in pediatric ED patients.
- To compare outcomes of IV iron sucrose with traditional red blood cell (RBC) transfusion.
Main Methods:
- Retrospective analysis of pediatric patients with severe IDA presenting to a children's ED from 2017-2021.
- Severe IDA defined as hemoglobin <70 g/L with low ferritin or clinical diagnosis.
- Outcomes assessed included hemoglobin rise, adverse reactions, and ED return visits.
Main Results:
- Of 57 patients, 13 received IV iron sucrose; their hemoglobin levels were comparable to transfused patients after two weeks.
- The median time to increase hemoglobin by 20 g/L with IV IS was 7 days.
- IV iron sucrose had mild reactions (2), while RBC transfusion had mild reactions (3) and one case of transfusion-associated circulatory overload (TACO). No patients returned to the ED within 30 days due to anemia.
Conclusions:
- IV iron sucrose is a safe and effective strategy for managing severe IDA in hemodynamically stable children.
- This treatment facilitates a rapid hemoglobin increase, avoiding risks associated with RBC transfusions.
- Further pediatric-specific guidelines and prospective studies are needed to optimize IV iron use.
Background:
Transfusion is discouraged in hemodynamically stable children with severe iron deficiency anemia (IDA). Intravenous (IV) iron sucrose (IS) could be an alternative for some patients; however, there is a paucity of data on its use in the paediatric emergency department (ED).
Methods:
We analyzed patients presenting with severe IDA at the Children's Hospital of Eastern Ontario (CHEO) ED between September 1, 2017, and June 1, 2021. We defined severe IDA as microcytic anemia <70 g/L and either a ferritin <12 ng/mL or a documented clinical diagnosis.
Results:
Of 57 patients, 34 (59%) presented with nutritional IDA and 16 (28%) presented with IDA secondary to menstrual bleeding. Fifty-five (95%) patients received oral iron. Thirteen (23%) patients additionally received IS and after 2 weeks, the average Hgb was similar to transfused patients. The median time for patients receiving IS without PRBC transfusion to increase their Hgb by at least 20 g/L was 7 days (95%CI 0.7 to 10.5 days). Of 16 (28%) children who were transfused with PRBC, there were three mild reactions, and one patient who developed transfusion associated circulatory overload (TACO). There were two mild and no severe reactions to IV iron. There were no return visits to the ED due to anemia in the following 30 days.
Conclusions:
Management of severe IDA with IS was associated with a rapid rise in Hgb without severe reactions or returns to ED. This study highlights a strategy for management of severe IDA in hemodynamically stable children that spares them the risks associated with PRBC transfusion. Paediatric specific guidelines and prospective studies are needed to guide the use of IV iron in this population.
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