Iron Deficiency Anemia: The Most Common Anemia

Anemia happens when a person has low levels of red blood cells. Iron deficiency is the most common type of anemia (according to the American Society of Hematology). Iron is a mineral that the body needs to make a protein called hemoglobin. Red blood cells contain hemoglobin. Hemoglobin carries oxygen to all the parts of the body. When you don’t have enough hemoglobin, the body tissues don’t get all the oxygen they need.

Causes of iron deficiency anemia:

1. Not taking in enough iron in the diet. Foods like red meats, eggs, and some leafy green veggies are high in iron. So the kid who eats nothing but mac n’ cheese, white bread, and milk is high risk.
2. Pregnancy or blood loss (e.g., during periods)
3. Internal bleeding. Conditions like bleeding ulcers and polyps can cause bleeding.
4. Inability to absorb iron. Certain conditions (e.g., celiac disease, Crohn disease) and surgeries (e.g., intestinal surgeries) may make it so the body can’t absorb the iron that it needs. Certain medications (like taking too many antacids that have calcium) can also inhibit absorption of iron.

High Risk Kids:

1. Premies
2. Kids with poor diets
3. Babies who are exclusively breast fed for prolonged periods (esp. if mom tends to be iron deficient)
4. Kids with chronic diseases
5. Vegetarians
6. Kids who drink too much milk (more than 24 oz/day)-milk has no iron and can decrease absorption of iron
7. Bleeders (e.g., girls with heavy menstrual periods, kids with bleeding disorders, etc.)

Symptoms:

1. Overall crummy feeling
2. Tired/fatigue
3. Weak
4. Pale skin
5. Dizziness
6. Shortness of breath
7. Tingling or crawling legs (restless leg syndrome)
8. Cold hands and feet
9. Brittle nails
10. Fast or irregular heart beat
11. Headaches
12. Tongue swelling or soreness
13. PICA (unusual cravings for things that aren’t food, like ice and dirt). See article “PICA.”

Long-term complications if untreated.

In addition to the terrible symptoms previously mentioned, kids who are anemic have long term problems if they go untreated. The most notable is that they don’t grow well and have lower IQs long term. It makes sense, you have to have blood for the brain and body to grow and develop appropriately. Kids who are anemic are also at higher risk of getting infections. They just don’t have the defenses that they need.

How is it diagnosed?

Unfortunately, the only way to truly determine if a person has iron deficiency is through blood work. Commonly a CBC (or complete blood count) will be done. As part of the CBC, the doctor will look at the size of the blood cells (called the mean cellular volume-MCV). In kids who are iron deficient, the MCV is low. Additionally, further testing for iron levels (including tests called a ferritin, iron, and total iron binding capacity) will also be done. These tests allow a pediatrician to get a clear picture of iron and iron stores in the body, thereby helping guide treatment.

If the cause of the iron deficiency isn’t readily apparent (e.g., a kid who has a really poor diet), your pediatrician may also do further testing to help determine the cause.

Why not just treat anemia?

Iron is a tricky little mineral. If you take too much, you can get iron toxicity (and damage the liver). If you don’t get enough, you have all the problems associated with iron deficiency. Iron supplementation and following levels should be directed under the care of a physician.

How is anemia treated?

In addition to correcting the underlying cause (e.g., eating an iron rich diet or stopping internal bleeding), your pediatrician will recommend iron supplementation. Usually the supplementation is with oral ferrous sulfate. Ideally it is given 2-3 times a day (to improve absorption). I warn you that liquid iron preparations taste bad and kids don’t like them. A little trick that I have learned over time is that chocolate syrup has a strong flavor and can hide the taste of the medicine if needs be. When you look at the potential badness that happens from not treating, it will motivate you as the parent to fight the medicine fight if needs be. Treatment typically lasts a few months (between 2-6 months). It is also common to have follow-up blood tests to monitor treatment. Please note that while vitamins with iron can help maintain a child’s iron once normal, vitamins are not enough to treat iron deficiency. FYI, vitamin C helps improve iron absorption, while calcium inhibits iron absorption.

It is also worth mentioning that in extreme cases a blood transfusion or iron infusion (IV) may be the treatment of choice. These cases are usually involving kids with severe symptoms (unstable) or active, uncontrolled bleeding.

Screening:

Your pediatrician should have some sort of screening plan as part of the regular well child checks. In my office, we do routine hemoglobin checks at the 1-year, kindergarten, and junior high physicals (or in girls, once they have started having their periods). In addition, I will screen any child who is at risk or has symptoms sooner. In my office, if the screened hemoglobin is low, I will then do the complete testing (including CBC, iron, TIBC, and ferritin) to ensure a true positive and help guide treatment.

If you have concerns about your child potentially being iron deficient, make sure and bring it up with your pediatrician.