Paediatric haemoglobin and optimisation template ANAEMIAa Hb below reference range for age, sex and gestation Ferritin <20 mcg/L Ferritin 20–50 mcg/L Ferritin >50 mcg/L Iron deficiency anaemia Possible iron deficiency anaemia Unlikely iron deficiency anaemia Review clinical history and identify cause Review and address any causes of iron Correlate with MCH/MCV and CRP Ferritin (see deficiency may be elevated in the setting of Table 1 below) (see Column 1) inflammation. However, iron deficiency Start treatment: may still be present, particularly where Correlate with MCV/MCH and CRP iron 3–6 mg/kg/day TSAT <20%. Address causes of dietary iron deficiency: Consider therapeutic of iron: Consider alternative causes of anaemia: dietary iron iron 3 mg/kg/day and other <1 year of age, cease cow’s milk Assess haematological response within 2–4 haemoglobinpathies and use an infant formula weeks of chronic disease 1–2 years of age, reduce cow’s If anaemia persists, consider other causes anaemia milk to (see Column 3) deficiency <500 mL daily deficiency Assess haematological response within 2-4 Continue treatment for 3 months after Hb recovery If oral iron is ineffective or is not tolerated, consider trial causes of anaemia (see Column 3) and use of IV iron a This algorithm applies to all patients, including those undergoing procedures in which substantial blood loss is anticipated. The reference ranges are based on criteria from the Royal College of Pathologists of Australasia(), and they may require local adaptation. CRP, C reactive protein; Hb, haemoglobin; IV, intravascular; MCH, mean corpuscular haemoglobin; MCV, mean corpuscular volume; TSAT, transferrin saturation
Paediatric haemoglobin and optimisation template ANAEMIAa Hb below reference range for age, sex and gestation Ferritin <20 mcg/L Iron deficiency anaemia Ferritin 20–50 mcg/L Possible iron deficiency anaemia Ferritin >50 mcg/L Unlikely iron deficiency anaemia Review clinical history and identify cause (see Table 1 below) Start treatment: iron 3–6 mg/kg/day Address causes of dietary iron deficiency: dietary iron <1 year of age, cease cow’s milk and use an infant formula 1–2 years of age, reduce cow’s milk to <500 mL daily Assess haematological response within 2-4 Continue treatment for 3 months after Hb recovery If oral iron is ineffective or is not tolerated, consider causes of anaemia (see Column 3) and use of IV iron Review and address any causes of iron deficiency (see Column 1) Correlate with MCV/MCH and CRP Consider therapeutic trial of iron: iron 3 mg/kg/day Assess haematological response within 2–4 weeks If anaemia persists, consider other causes (see Column 3) Correlate with MCH/MCV and CRP Ferritin may be elevated in the setting of inflammation. However, iron deficiency may still be present, particularly where TSAT <20%. Consider alternative causes of anaemia: and other haemoglobinpathies of chronic disease anaemia deficiency deficiency a This algorithm applies to all patients, including those undergoing procedures in which substantial blood loss is anticipated. The reference ranges are based on criteria from the Royal College of Pathologists of Australasia(), and they may require local adaptation. CRP, C reactive protein; Hb, haemoglobin; IV, intravascular; MCH, mean corpuscular haemoglobin; MCV, mean corpuscular volume; TSAT, transferrin saturation
Paediatric-and-Neonatal-Iron-Deficiency-Anaemia-Guide-Final-Dec17.docx