Pediatr Blood Cancer 2016;63:743–745
BRIEF REPORT Deficiencies in the Management of Iron Deficiency Anemia During Childhood Jacquelyn M. Powers, MD,1,2∗ Catherine L. Daniel, MD,3 Timothy L. McCavit, MD, MS,1,2 and George R. Buchanan, MD1,2 Limited high-quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid2010. The majority of children were ࣘ4 years old (64%) and had nutritional IDA (74%). In 11- to 18-year-old patients (31%), the pri-
Key words:
mary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lostto-follow-up were common. Substantial improvements are required in the management of IDA. Pediatr Blood Cancer 2016;63:743– 745. C 2016 Wiley Periodicals, Inc.
adolescent; infant; iron deficiency anemia; management
INTRODUCTION Despite declining prevalence, iron deficiency anemia (IDA) during childhood remains a common and serious problem[1,2] being especially prevalent in toddlers aged 12–36 months and females with menorrhagia.[3] Sequelae from IDA include longterm neurocognitive deficits, fatigue, pica, and in severe cases high-output heart failure or stroke.[4] Much attention has focused on prevention and early diagnosis of IDA,[5–7] yet little research has assessed treatment and follow-up of those children in whom IDA is diagnosed in spite of preventive strategies.[8] A recently published survey indicates wide variation in pediatric hematology–oncology specialists’ self-reported management of patients with IDA,[9] resulting in part from the lack of contemporary scientific literature regarding evidence-based treatment of IDA.[8,10,11] Few studies have been published in either young children with nutritional IDA or adolescents with heavy menstrual bleeding—the two patient populations at greatest risk—to determine which formulations and dosage schedules are most tolerable and effective.[8] In 2011, our center initiated a formal IDA Program that included the establishment of standard practices for IDA management and a subsequent clinical trial for young patients with nutritional IDA.[12] To characterize how IDA had previously been managed locally, we examined records of children with IDA referred to our center during the 4.5-year period prior to this initiative.
ments were abstracted into Microsoft Excel 2007TM for each subject (Table I). Patients were considered lost-to-follow-up if the last encounter in the EMR was a missed or cancelled hematology appointment. Analyses with Microsoft Excel were descriptive and included proportions, mean with standard deviation, median with range, and cross-tabulations.
Patient Characteristics One hundred ninety-five new patients had confirmed IDA during the study frame (Table II). In young children, the etiology was primarily nutritional, while in adolescents it was heavy menstrual bleeding (42%). Some children had multiple causes of IDA, and an etiology was not recorded in 17 patients.
Treatment of Iron Deficiency Prior to Initial Hematology Consultation IDA treatment had been initiated by the primary care provider in 83 of the 195 patients (43%) prior to referral. Among young children for whom the elemental iron dosing could be determined (n = 59), 35 (59%) were prescribed doses outside the recommended range of 3–6 mg/kg/day. Of those, 29 (83%) were prescribed
BRIEF REPORT Deficiencies in the Management of Iron Deficiency Anemia During Childhood Jacquelyn M. Powers, MD,1,2∗ Catherine L. Daniel, MD,3 Timothy L. McCavit, MD, MS,1,2 and George R. Buchanan, MD1,2 Limited high-quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid2010. The majority of children were ࣘ4 years old (64%) and had nutritional IDA (74%). In 11- to 18-year-old patients (31%), the pri-
Key words:
mary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lostto-follow-up were common. Substantial improvements are required in the management of IDA. Pediatr Blood Cancer 2016;63:743– 745. C 2016 Wiley Periodicals, Inc.
adolescent; infant; iron deficiency anemia; management
INTRODUCTION Despite declining prevalence, iron deficiency anemia (IDA) during childhood remains a common and serious problem[1,2] being especially prevalent in toddlers aged 12–36 months and females with menorrhagia.[3] Sequelae from IDA include longterm neurocognitive deficits, fatigue, pica, and in severe cases high-output heart failure or stroke.[4] Much attention has focused on prevention and early diagnosis of IDA,[5–7] yet little research has assessed treatment and follow-up of those children in whom IDA is diagnosed in spite of preventive strategies.[8] A recently published survey indicates wide variation in pediatric hematology–oncology specialists’ self-reported management of patients with IDA,[9] resulting in part from the lack of contemporary scientific literature regarding evidence-based treatment of IDA.[8,10,11] Few studies have been published in either young children with nutritional IDA or adolescents with heavy menstrual bleeding—the two patient populations at greatest risk—to determine which formulations and dosage schedules are most tolerable and effective.[8] In 2011, our center initiated a formal IDA Program that included the establishment of standard practices for IDA management and a subsequent clinical trial for young patients with nutritional IDA.[12] To characterize how IDA had previously been managed locally, we examined records of children with IDA referred to our center during the 4.5-year period prior to this initiative.
ments were abstracted into Microsoft Excel 2007TM for each subject (Table I). Patients were considered lost-to-follow-up if the last encounter in the EMR was a missed or cancelled hematology appointment. Analyses with Microsoft Excel were descriptive and included proportions, mean with standard deviation, median with range, and cross-tabulations.
Patient Characteristics One hundred ninety-five new patients had confirmed IDA during the study frame (Table II). In young children, the etiology was primarily nutritional, while in adolescents it was heavy menstrual bleeding (42%). Some children had multiple causes of IDA, and an etiology was not recorded in 17 patients.
Treatment of Iron Deficiency Prior to Initial Hematology Consultation IDA treatment had been initiated by the primary care provider in 83 of the 195 patients (43%) prior to referral. Among young children for whom the elemental iron dosing could be determined (n = 59), 35 (59%) were prescribed doses outside the recommended range of 3–6 mg/kg/day. Of those, 29 (83%) were prescribed
