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Anaemia
Screening for Iron Deficiency Anemia, including Iron Supplementation for Children and Pregnant Women
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The U.S. Preventive Services Task Force (USPSTF) concludes that evidence is insufficient to recommend for or against routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months. (I).
The USPSTF recommends routine screening for iron deficiency anemia in asymptomatic pregnant women. (B)
The USPSTF concludes that evidence is insufficient to recommend for or against routine iron supplementation for asymptomatic children aged 6 to 12 months who are at average risk for iron deficiency anemia. (I)
The USPSTF concludes that evidence is insufficient to recommend for or against routine iron supplementation for non-anemic pregnant women. (I)
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Clinical Considerations
- These USPSTF recommendations address screening for iron deficiency anemia and iron supplementation in asymptomatic pregnant women and in non-anemic pregnant women. Men are not addressed.
- Iron deficiency anemia can be defined as iron deficiency (abnormal values for serum ferritin, transferrin saturation, and free erythrocyte protoporphyrin) with a low hemoglobin or hematocrit value. Iron deficiency is much more common than iron deficiency anemia and is part of a continuum that ranges from iron depletion to iron deficiency anemia. Many of the negative health outcomes of iron deficiency are associated with its extreme manifestation, iron deficiency anemia. Iron deficiency has also been associated with negative neurodevelopmental outcomes in children.
- Other causes of anemia vary by population and include other nutritional deficiencies, abnormal hemoglobin (e.g., thalassemia), enzyme defects, and anemia associated with acute and chronic infections.
- Race, income, education, and other socioeconomic factors are associated with iron deficiency anaemia. Individuals considered being at high risk for iron deficiency include adult females, recent immigrants, adolescent females, and those who are obese. Premature and low birth weight infants are also at increased risk for iron deficiency.
- Venous hemoglobin is more accurate than capillary hemoglobin for identifying anemia. Ferritin has the highest sensitivity and specificity for diagnosing iron deficiency in anemic patients.
- Iron deficiency anemia is usually treated with oral iron preparations. The likelihood that iron deficiency anemia identified by screening will respond to treatment is unclear because many families do not adhere to treatment and because the rate of spontaneous resolution is high.
- Iron supplements accounted in high percent of fatal pediatric pharmaceutical overdoses, and iron poisoning has been observed even in the context of controlled trials in which parents were instructed in the safe storage and use of iron products.
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