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Laboratory
Tests: Iron-Deficiency
Anemia Screening
Iron deficiency
is the most common cause of anemia in U.S. children and adolescents.
The risk of anemia is greatest in infancy and adolescence because
of increased iron requirements during these periods of rapid growth.
Risk
Assessment and Health Education
Assess child's
or adolescent's risk of iron-deficiency anemia, and provide targeted
health
education/guidance,
treatment, and referrals as needed. Assess risk through:
- Review of
health history and risk factors (e.g., low birthweight or preterm
birth, non-iron-fortified formula, cow's milk before age 12 months,
inadequate nutrition, heavy menstrual periods, intensive physical
training)
- Review of
nutrition assessment
(quality and quantity
of daily food intake)
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Periodicity
and Guidelines for Anemia Screening |
HealthCheck
requires iron-deficiency anemia screening at key developmental ages
(more frequently if child or teen is at high risk):
Infancy
and Early Childhood:
- Screen
all infants at 9-12 months
- If infant
at high risk: Screen earlier than 9 months
- If child
at high risk: Screen again at 15, 18, and 24 months
Childhood:
- If child
at high risk: Screen at each preventive health visit from
3-10 years
Adolescence:
- Screen
once between 11 and 20 years
- Screen
menstruating females annually
Screening
Guidelines
Screen with
a blood test (hematocrit or hemoglobin), using one of these methods:
- Venipuncture
with analysis by automated cell counter
- Capillary
puncture with microhematocrit analysis by centrifuge
If the microhematocrit
method is used, follow the principles of collection listed below:
- In infants,
collect the sample from medial or lateral aspect of the plantar
surface of the heel. In older children, collect the sample from
the medial or lateral aspects of the pulp of the finger. Make
the puncture perpendicular to the skin and across the dermal ridges.
- To increase
blood flow, apply a warm (100° to 108° F) moist towel
to the site.
- Avoid massaging
the collection site, since this may dilute the sample with tissue
fluids.
- Before puncturing
the skin, clean the site with an antiseptic and let it dry.
- For infants
6 months or younger: Use sterile, disposable lancets with tips
less than 2.5mm long should be used. For older children: lancets
with longer tips (up to 5mm) may be used.
- Wipe away
the first drop of blood (which contains tissue fluid) with dry
sterile gauze.
Resources
Centers
for Disease Control and Prevention. 1998. Recommendations to prevent
and control iron deficiency in the United States. MMWR 47
(No. RR-3)
Story
M, Holt, K, Sofka D, eds. 2002. Bright Futures in Practice: Nutrition
(2nd ed.) [chapter on Iron-Deficiency Anemia: pp. 196-202]. Arlington,
VA: National Center for Education in Maternal and Child Health.
Also available online at www.brightfutures.org/nutrition/pdf/index.html.
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