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Outcome of children identified as anemic by routine screening in an inner-city clinic.
Arch Pediatr Adolesc Med. 2001 Mar; 155(3):366-71.AP

Abstract

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.

Authors+Show Affiliations

General Academic Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Room G205, Pittsburgh, PA 15213, USA. bogend@chplink.chp.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11231803

Citation

Bogen, D L., et al. "Outcome of Children Identified as Anemic By Routine Screening in an Inner-city Clinic." Archives of Pediatrics & Adolescent Medicine, vol. 155, no. 3, 2001, pp. 366-71.
Bogen DL, Krause JP, Serwint JR. Outcome of children identified as anemic by routine screening in an inner-city clinic. Arch Pediatr Adolesc Med. 2001;155(3):366-71.
Bogen, D. L., Krause, J. P., & Serwint, J. R. (2001). Outcome of children identified as anemic by routine screening in an inner-city clinic. Archives of Pediatrics & Adolescent Medicine, 155(3), 366-71.
Bogen DL, Krause JP, Serwint JR. Outcome of Children Identified as Anemic By Routine Screening in an Inner-city Clinic. Arch Pediatr Adolesc Med. 2001;155(3):366-71. PubMed PMID: 11231803.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of children identified as anemic by routine screening in an inner-city clinic. AU - Bogen,D L, AU - Krause,J P, AU - Serwint,J R, PY - 2001/3/20/pubmed PY - 2001/4/17/medline PY - 2001/3/20/entrez SP - 366 EP - 71 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 155 IS - 3 N2 - 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. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/11231803/Outcome_of_children_identified_as_anemic_by_routine_screening_in_an_inner_city_clinic_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/vol/155/pg/366 DB - PRIME DP - Unbound Medicine ER -