Navigating treatment dilemmas in severe paediatric IDA: A case report

Area of Science:

• Pediatric Hematology
• Nutritional Anemias
• Transfusion Medicine

Background:

• Iron deficiency anemia (IDA) is a global health issue.
• Severe pediatric IDA presents management challenges, particularly regarding transfusion versus intravenous (IV) iron.
• Optimal treatment thresholds for packed red blood cell (pRBC) transfusion in stable, severely anemic pediatric patients remain unclear.

Purpose of the Study:

• To report a case of severe nutritional IDA in an adolescent managed with IV iron.
• To discuss the therapeutic dilemma between pRBC transfusion and IV iron in clinically stable, severely anemic pediatric patients.
• To highlight the need for updated pediatric guidelines on IDA management.

Main Methods:

• Case report of a 16-year-old male with severe nutritional IDA.
• Management with IV iron followed by oral iron supplementation.
• Monitoring of hemoglobin levels and clinical status.

Main Results:

• Rapid hemoglobin recovery (13 g/L increase in 5 days) following IV iron administration.
• Slow functional recovery, taking 6 months.
• Patient declined pRBC transfusion, opting for IV iron therapy.

Conclusions:

• IV iron is a feasible alternative to pRBC transfusion in stable adolescents with severe IDA.
• Clinical stability in severe IDA may warrant consideration of IV iron over immediate transfusion.
• Paediatric guidelines are needed to clarify transfusion thresholds and the role of IV iron in severe IDA.