In this section
Patient Blood Management in the surgical setting
Patient blood Management and surgery algorithm
The Australian Red Cross Blood Service – iron deficiency anaemia overview
This guideline is adapted from the National Blood Authority (NBA) Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics (2016)
Iron deficiency is the most common cause of anaemia in children.
Iron deficiency in infants and toddlers is predominantly a nutritional disorder; (insufficient red meat or excessive cow milk consumption); rarely due to malabsorption or gastrointestinal bleeding.
Risk factors include
Symptoms of low ferritin:
Serum ferritin is the most useful screening test for assessing iron stores. A ferritin of
<20 μg/L is taken to indicate borderline/low iron stores.
Iron studies or serum iron should not be requested to diagnose iron deficiency.
A FBC is needed to diagnose IDA, most commonly the red blood cells are microcytic and hypochromic (reduced MCV and MCH).
Suggest iron supplementation and dietary modification if low ferritin, with or without anaemia.
Adolescent gynecology – heavy menstrual bleeding
Oral iron formulations
Spansules can be opened and the beads sprinkled on food to give lower doses
They should not be crushed or chewed
Over the counter multi-vitamin or minerals supplements do not contain sufficient iron to treat iron deficiency anaemia and should not be used.
Mild to moderate IDA - to provide 3mg/kg/day
Note: doses in patients > 40kg are usually limited to one spansule / tablet per day unless no improvement in Hb and reticulocyte count.
Severe IDA (Hb 80 g/L or less) - to provide 6mg/kg/day
Note: doses are usually limited to one spansule / tablet per day unless no improvement in Hb and reticulocyte count.
Intravenous iron should be considered in the following circumstances:
The cause of iron deficiency is unclear.
Children require care beyond the level of comfort of the local hospital.
For emergency advice and paediatric or neonatal ICU transfers, call
the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137
Iron RCH nutrition and food services
Consider discussion with clinical haematology