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Iron Deficiency Anemia in Children During and After PICU Stay: Single-Center Retrospective Cohort, 2021-2022
Akhila Vadivelan1,2, Elizabeta Nemeth2, Tomas Ganz2,3
1Department of Pediatrics, Division of Hematology/Oncology, UCLA, Los Angeles, CA.
Insights
Iron deficiency anemia monitoring and follow-up in pediatric intensive care units (PICUs) are insufficient. Many children remain anemic post-PICU discharge, highlighting a need for improved screening and care strategies.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Nutritional science
Background:
- Iron deficiency anemia (IDA) is a common condition with significant health implications in children.
- Effective monitoring and management of IDA in critically ill children within the Pediatric Intensive Care Unit (PICU) setting are crucial for optimal outcomes.
- Current practices for identifying and managing IDA during and after PICU stays require evaluation.
Purpose of the Study:
- To assess the current practices for monitoring iron deficiency (ID) and anemia in children during their PICU admission.
- To evaluate the follow-up strategies for IDA in pediatric patients after PICU discharge.
- To identify gaps in the current management of IDA in this vulnerable population.
Main Methods:
- A retrospective observational study was conducted over two years (2021-2022) at a single-center academic PICU in the United States.
- Data were collected on patients under 18 years old, excluding those who died during PICU stay or within six months post-discharge.
- Iron studies (serum iron, TSAT, ferritin) and hemoglobin levels were analyzed at PICU admission, discharge, and at 3 and 6 months post-discharge.
Main Results:
- Of 1275 patients, 913 met inclusion criteria, with 492 diagnosed with anemia (hemoglobin < 11 g/dL).
- Only 18.9% of anemic patients underwent iron studies during their PICU stay.
- At 3 and 6 months post-discharge, 55% and 50% of patients, respectively, remained anemic, with a significant proportion still having ID or suspected ID (SID).
Conclusions:
- Current practices for detecting iron deficiency and providing follow-up care for IDA in children post-PICU are inadequate.
- A substantial number of children continue to experience anemia after PICU discharge, indicating a need for more robust management protocols.
- Future research should investigate the efficacy of universal screening for ID at PICU discharge and subsequent follow-up.
Objectives:
The primary objective was to determine iron deficiency (ID) anemia (IDA) monitoring practices in children during PICU stay. A secondary objective was to determine the current follow-up practices for IDA after PICU discharge.
Design:
Retrospective observational study of 2 years (2021-2022).
Setting:
Single-center academic PICU in the United States.
Subjects:
All patients younger than 18 years and excluded patients who died in the PICU or within 6 months of PICU discharge.
Interventions:
None.
Measurements And Main Results:
Anemia was defined by a hemoglobin concentration of less than 11 g/dL. ID was defined by either a ferritin of less than 30 ng/mL or a transferrin saturation (TSAT) of less than or equal to 20%. Suspicion for functional iron deficiency (SID) was defined by ferritin greater than or equal to 30 ng/mL and TSAT less than or equal to 20%, given the hyperferritinemic effect of inflammation. We documented serum iron, total iron binding capacity, TSAT, ferritin, and hemoglobin at PICU admission and discharge and 3 and 6 months after discharge. Overall, 913 of 1275 met the inclusion criteria, and 492 patients had a hemoglobin of less than 11 g/dL. Only 93 of 492 (18.9%) had iron studies at any time during the PICU stay. Among the 93 patients with iron studies, 20 patients (22%) were lost to follow-up. Of the remaining 73 patients, 67 of 73 had a hemoglobin checked at 3 months, of which 37 of 67 (55%) were still anemic. At 6 months, there were 64 of 73 patients who had a hemoglobin checked, of which 32 of 64 (50%) were still anemic. At 3 months, 39 of 73 (53%) had iron studies performed; of these, 13 of 39 had ID, 12 of 39 had SID, and 14 of 39 had neither ID nor SID. At 6 months, 35 of 73 (48%) had iron studies; of these, ten of 35 had ID, 11 of 35 had SID, and 14 of 35 had neither ID nor SID.
Conclusions:
Detection of ID and follow-up after PICU stay remain inadequate. We recommend that future studies assess the value of screening all critically ill patients for ID at the time of discharge and followed up, as necessary.
