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Management of Childhood Iron Deficiency Anemia in a Developed Country-A Multi-Center Experience from Croatia
Izabela Kranjčec1, Nuša Matijašić Stjepović1, Domagoj Buljan1
1Department of Oncology and Hematology, Children's Hospital Zagreb, 10000 Zagreb, Croatia.
Insights
Childhood iron deficiency anemia (IDA) is a significant health issue in Croatia. Improved primary care diagnostics and consistent guideline implementation are crucial for managing this condition effectively.
Area of Science:
- Pediatrics
- Hematology
- Public Health
Background:
- Childhood iron deficiency anemia (IDA) remains a global health concern, with limited epidemiological data specific to Croatia.
- IDA significantly impacts child health, necessitating a thorough understanding of its prevalence and management within the country.
Purpose of the Study:
- To determine the frequency, causes, and management of childhood IDA in Croatia.
- To analyze diagnostic practices and treatment regimens for IDA in tertiary care settings.
- To identify variations in care and inform strategies for improved pediatric hematology services.
Main Methods:
- Retrospective analysis of medical records for children referred for iron deficiency over five years.
- Data collected from tertiary pediatric hematology centers across Croatia (Zagreb, Rijeka, Split, Osijek).
- Inclusion of 864 children, primarily preschool-aged, referred by primary care physicians.
Main Results:
- Inadequate nutrition was a common cause, with one-third of patients symptomatic.
- Primary care physicians often performed basic diagnostics but delayed oral iron therapy initiation.
- Dextriferron was the preferred parenteral iron formulation; compliance rates varied (63.5-93.2%).
- Significant variations observed in hospitalization (9.4-35%), transfusion policies (6.4-22.9%), and parenteral iron use (0.3-21.5%) across centers.
Conclusions:
- Childhood IDA poses a substantial burden even in high-income countries like Croatia.
- Consistent implementation of national guidelines and enhanced education for primary care providers are essential.
- Addressing diagnostic and therapeutic inconsistencies can improve outcomes for children with IDA.
Abstract:
Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic practices, and current treatment regimens of IDA, medical records of children referred to pediatric hematologists for iron deficiency in a five-year period at tertiary institutions (Zagreb, Rijeka, Split, Osijek) throughout Croatia were retrospectively analyzed. Eight hundred and sixty-four children, predominately of preschool age, were referred mainly by the primary care pediatricians, who, in general, performed basic diagnostics but failed to initiate oral iron therapy in half of the patients. Approximately one-third of patients were symptomatic, with inadequate nutrition prevailing as underlying etiology. Dextriferron was the preferred iron formulation among hematologists, with a median dose of 5 mg/kg, with acceptable compliance rates (63.5-93.2%). Hospital admission rates varied among the centers (9.4-35%), and so did transfusion policies (6.4-22.9%). The greatest difference was observed in the frequency of parenteral iron administration (0.3-21.5%). In conclusion, the burden of childhood IDA, even in a high-income country, remains substantial, necessitating consistent implementation of national guidelines and additional education of primary health care providers.
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