Screening toddlers for iron deficiency anaemia in general practice

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7125.145 (Published 10 January 1998) Cite this as: BMJ 1998;316:145

No investigation can accurately separate normal from pathological

  1. David Stevens, Consultanta
  1. a Paediatric Department, Gloucestershire Royal Hospital, Gloucester GL1 3NN
  2. b Institute of Child Health, University of Birmingham, Birmingham B16 8ET
  3. c Northern Birmingham Community Trust, Carnegie Centre, Birmingham B19 1DR
  4. d Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  5. e Department of Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH
  6. f Leicestershire Community NHS Trust, Leicester LE5 0TD

    Editor—James et al state that iron deficiency anaemia in infancy is present when the haemoglobin concentration is < 110 g/l.1 Using this definition, they go on to say that 15% of infants in a relatively affluent area of Bristol had iron deficiency anaemia. They do not mention the possibility that children with haemoglobin concentrations of <110 g/l can have other causes of a low concentration or can be healthy and have what Dallman has called “false anaemia.”2 Burman found that 16% (<1 SD) of infants aged 15 months who had had continuous iron supplementation had haemoglobin concentrations of <110 g/l.3 Burman's findings, obtained in the same age group as that studied by James et al and in the same city, provide strong evidence that a haemoglobin concentration of <110 g/l is not synonymous with iron deficiency anaemia.

    Iron deficiency is a common cause of anaemia in young children, but it is not the commonest cause in all groups of children.4 5 Dallman has pointed out that much of the anaemia seen in paediatric practice is due to mild acute infections and that many children with low haemoglobin concentrations are healthy and have no illness.5 The lower limit of normal haemoglobin concentration at this age, as stated by the World Health Organisation, is merely a statistical cut off point and does not tell us which children have a pathological cause for a “low” haemoglobin concentration. Some children with haemoglobin concentrations of >110 g/l are iron deficient and some with concentrations below this value are iron replete.4 Similarly, laboratory tests of iron status, such as measurement of serum ferritin concentration, do not have clearly defined cut off values that can be used to identify those infants whose haemoglobin concentrations will rise, let alone those whose developmental …

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