The Burden of Childhood Iron Deficiency Anemia in a Developed Country: A Croatian Tertiary Care Center Experience

Given the high prevalence of unrecognized iron deficiency anemia (IDA) in Croatia and its negative impact on children's somatic and neurological outcomes, a comprehensive preventive and treatment approach is a necessity.  Methods: This was an observational, cross-sectional study of pediatric patients referred to the Children's Hospital Zagreb, Croatia, from 2017 to 2021, for IDA. Epidemiological and clinical data were extracted. Laboratory workup and therapeutic actions in the primary and tertiary care settings were recorded. The need for transfusion, parenteral iron therapy, and hospital admission was noted.

A total of 299 patients (52.2% female, median five years) were seen by the hematologist in the five-year study period. Almost half (45.1%) were referred by the primary care pediatrician. Only half of the patients (56.6%) received oral iron therapy prior to referral. The preferred preparation was Dextriferron (67.7%) during the mean period of 5.8 months, but more than one-third of the patients (36.5%) were non-compliant. Every 10th child seen by the hematologist for IDA was admitted to the hospital; 6.4% required transfusion therapy, and in only one patient, parenteral iron was administered.  Conclusions: The results of this survey established that IDA still represents an excessive burden in a tertiary care setting of a high-income country. Therefore, consistent implementation of national guidelines and additional education of primary healthcare providers is crucial to ameliorate this significant public health concern.