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Outcome of Children Identified as Anemic by Routine Screening in an Inner-city Clinic
Debra L. Bogen, MD;
Jennifer P. Krause, MD;
Janet R. Serwint, MD
Arch Pediatr Adolesc Med. 2001;155:366-371.
Background Children found to be anemic on routine screening by HemoCue, a rapid
and relatively inexpensive method of screening for hemoglobin (Hb), are often
prescribed iron as a diagnostic tool and potential treatment for presumed
iron deficiency anemia (IDA). We questioned this approach given the declining
prevalence of IDA and the concomitant relative increase in other causes of
anemia.
Objective To evaluate the practice of Hb screening for IDA by determining the
prevalence of anemia by HemoCue; the proportion of anemic patients treated
with iron and followed up; the frequency of repeated Hb testing, additional
iron studies, and iron prescriptions; and the 6-month outcomes of treated
and untreated anemia.
Design Retrospective cohort study.
Results Of 1358 children aged 9 to 36 months who underwent screening, 343 (25%)
had anemia, defined as a Hb level of less than 110
g/L. Outpatient medical records of 334 of the anemic children revealed that
239 (72%) were prescribed iron while 95 (28%) were not prescribed iron at
the first visit for anemia. Anemia follow-up rates were low for the prescribed
and not prescribed groups: 7% vs 5% returned within 1 month, while 37% vs
42% did not return within 6 months for follow-up. Of the children who were
prescribed iron, 107 (71%) of 150 responded to treatment or anemia resolved
within 6 months compared with 27 (68%) of 40 not prescribed iron. Children
underwent repeated blood testing for measurement of Hb and complete blood
cell count, but underwent few iron-specific studies.
Conclusions Routine screening for IDA by HemoCue followed by a therapeutic trial
of iron was problematic because of a high rate of anemia in this predominantly
African American population, low follow-up rates, and a high spontaneous resolution
rate. Prospective studies are needed to evaluate other screening methods to
differentiate IDA from other forms of anemia and to improve compliance and
outcome in inner-city children.
From the Department of Pediatrics, The Johns Hopkins University School
of Medicine, Baltimore, Md. Dr Bogen is now affiliated with the Department
of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa,
and Dr Krause is now with Children's Hospital of Denver, Denver, Colo.
Corresponding author and reprints: Debra L. Bogen, MD, General Academic
Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Room G205,
Pittsburgh, PA 15213 (e-mail: bogend{at}chplink.chp.edu).
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