Outcome of children identified as anemic by routine screening in an inner-city clinic

Background: Children found to be anemic on routine screening by HemoCue, a rapid and relatively inexpensive method of screening for hemoglobin (Hb), a re often prescribed iron as a diagnostic tool and potential treatment for p resumed iron deficiency anemia (IDA). We questioned this approach given the declining prevalence of IDA and the concomitant relative increase in other causes of anemia. Objective: To evaluate the practice of Hb screening for IDA by determining the prevalence of anemia by HemoCue; the proportion of anemic patients trea ted with iron and followed up; the frequency of repeated Hb testing, additi onal iron studies, and iron prescriptions; and the 6-month outcomes of trea ted and untreated anemia. Design: Retrospective cohort study. Results: Of 1358 children aged 9 to 36 months who underwent screening, 343 (25%) had anemia, defined as a Hb level of less than 110 gn. Outpatient med ical records of 334 of the anemic children revealed that 239 (72%) were pre scribed iron while 95 (28%) were not prescribed iron at the first visit for anemia. Anemia follow-up rates were low for the prescribed and not prescri bed groups: 7% vs 5% returned within 1 month while 37% vs 42% did not retur n within 6 months for follow-up. Of the children who were prescribed iron, 107 (71%) of 150 responded to treatment or anemia resolved within 6 months compared with 27 (68%) of 40 not prescribed iron. Children underwent repeat ed blood testing for measurement of Hb and complete blood cell count, but u nderwent few iron-specific studies. Conclusions: Routine screening for IDA by HemaCue followed by a therapeutic trial of iron was problematic because of a high rate of anemia in this pre dominantly African American population, low follow-up rates, and a high spo ntaneous resolution rate. Prospective studies are needed to evaluate other screening methods to differentiate IDA from other forms of anemia and to im prove compliance and outcome in inner-city children.