The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 17

Families should be counseled
to wipe the teeth after
administration to prevent
discoloration and start a
stool softener, if needed, for
constipation.
absorption. Iron given on an empty stomach at
bedtime may enhance absorption since GI motil-
ity is decreased during sleep. 7 Absorption may
also be enhanced in the presence of ascorbic
acid, hence some clinicians recommend co-ad-
ministration with vitamin C supplements or forti-
fied juice. 7 More generally, oral iron requires an
acidic environment for optimal absorption. Chil-
dren who require daily antacids, H2 blockers, or
proton pump inhibitors may be resistant to oral
iron due to impaired absorption. 7
and prevention of iron deficiency and iron-
deficiency anemia in infants and young
children (0-3 years of age). Pediatrics.
2010;126(5):1040-1050.
2. Sekhar DL, Murray-Kolb LE, Kunselman
AR, Weisman CS, Paul IM. Differences in
Risk Factors for Anemia Between Adoles-
cent and Adult Women. J Womens Health.
2016;25(5):505-513.
3. Powers JM, Buchanan GR. Diagno-
sis and management of iron-deficiency
anemia. Hematol Oncol Clin North Am.
2014;28(4):729-745.
4. Witmer CM. Hematologic manifestations of
systemic disease (including iron deficiency,
anemia of inflammation and DIC). Pediatr
Clin North Am. 2013;60(6):1337-1348.
5. DeLoughery TG. Microcytic anemia. N Engl
J Med. 2014;371(14):1324-1331.
A CBC and reticulocyte count should be re-
peated four weeks after the initiation of treat-
ment. It is critical to evaluate a patient’s compli-
ance before interpreting results. If there is good
compliance and IDA is the correct diagnosis,
the reticulocyte count should be elevated and
hemoglobin should have increased by at least
1 g/dL. 1 If there is a positive response to treat-
ment, oral iron should be continued for at least
three months to replenish tissue iron stores and
minimize the possibility of recurrence of IDA.
Repeat labs should be drawn prior to discon-
tinuing treatment to ensure normalization of the
hemoglobin concentration, MCV, and serum fer-
ritin level. If hemoglobin does not respond as ex-
pected, several etiologies should be considered,
as described in Table 2. 6. Hermiston ML, Mentzer WC. A practical ap-
proach to the evaluation of the anemic child.
Pediatr Clin North Am. 2002;49(5):877-
891.
For patients who have impaired absorption,
intolerance, or remain resistant to oral
supplementation, there are several newer and
safer formulations of intravenous iron available.
A referral to hematology should be made if IV
iron therapy is indicated, the etiology of anemia
is unclear, or if the anemia remains refractory
despite adequate dosing and administration. 9. Powers JM, Buchanan GR, Adix L, Zhang S,
Gao A, McCavit TL. Effect of Low-Dose Fer-
rous Sulfate vs Iron Polysaccharide Com-
plex on Hemoglobin Concentration in Young
Children With Nutritional Iron-Deficiency
Anemia: A Randomized Clinical Trial. JAMA.
2017;317(22):2297-2304.
References:
1. Baker RD, Greer FR, Committee on Nutrition
American Academy of Pediatrics. Diagnosis
7. Fleming M. Disorders of Iron and Copper
Metabolism, the Sideroblastic Anemias,
and Lead Toxicity. In: Orkin S, Fisher D,
Ginsburg D, Look A, Lux S, Nathan D, eds.
Nathan and Oski’s Hematology of Infancy
and Childhood. Eighth ed. Philadelphia, PA:
Elsevier Saunders; 2015:344-381. Medical Board
Legal Issues?
8. Lanzkowsky P. Iron-Deficiency Anemia. In:
Lanzkowsky P, Lipton J, Fish J, eds. Lanz-
kowsky’s Manual of Pediatric Hematology
and Oncology. Sixth ed. San Diego, CA:
Academic Press; 2016:69-83. Call
Pharmacist/Attorney
10. Zlotkin S, Arthur P, Antwi KY, Yeung G.
Randomized, controlled trial of single
versus three-times-daily ferrous sulfate
drops for treatment of anemia. Pediatrics.
2001;108(3):613-616.
Darren O’Quinn
1-800-455-0581
www.DarrenOQuinn.com
Little Rock, Arkansas
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