Anaemia, Iron Deficiency
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: D50.9 DESCRIPTION Iron deficiency is the most common cause of anaemia. The commonest causes of iron deficiency anaemia are poor nutritional intake, excessive milk ingestion and blood loss due to parasites (whipworm and hookworm). Lower limits of normal haemoglobin: Age Hb (g/dL) Birth 13
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: D50.9
DESCRIPTION
Iron deficiency is the most common cause of anaemia. The commonest causes of iron deficiency anaemia are poor nutritional intake, excessive milk ingestion and blood loss due to parasites (whipworm and hookworm).
Lower limits of normal haemoglobin:
| Age | Hb (g/dL) |
| Birth | 13.5 |
| 6 weeks | 9.5 |
| 3 months | 10.0 |
| 6-12 months | 10.5 |
| 12-18 months | 10.5 |
| 18 months-4 years | 11.0 |
| 4-7 years | 11.0 |
| 7-12 years | 11.5 |
| 12 years and older | 12 (F) : 13 (M) |
DIAGNOSTIC CRITERIA
Clinical
Symptoms and signs vary with the severity of the deficiency:
- pallor,
- delayed motor development,
- fatigue,
- pica,
- irritability,
- soft ejection systolic murmur,
- behavioural and cognitive effects.
Investigations
- Haemoglobin below normal for age.
- Hypochromic microcytic anaemia.
- Low MCV (mean corpuscular volume) and MCH (mean corpuscular haemoglobin), increased red cell distribution width.
- Decreased serum iron, ferritin and transferrin saturation.
- Elevated total iron binding capacity.
- Stool examination to identify intestinal parasites or to confirm occult blood loss.
- Iron studies are not necessary if nutritional iron deficiency is strongly suspected. Document a response to a trial of iron therapy to confirm the diagnosis.
Note: Chronic infections may also cause microcytic hypochromic anaemia.
See: Anaemia of chronic disorders (infection or disease).
GENERAL AND SUPPORTIVE MEASURES
- Dietary adjustment.
- Counselling.
MEDICINE TREATMENT
Treatment
In the presence of an acute, severe infection, delay initiating iron supplements until the infection resolves.
- Iron (elemental), oral, 3 mg/kg/dose 12 hourly with meals.
- Follow up monthly.
Elemental iron per preparation
| Ferrous gluconate elixir | 350 mg/5 mL | 40 mg elemental iron per 5 mL | 8 mg elemental iron per mL |
| Ferrous gluconate syrup | 250 mg/5 mL | 30 mg elemental iron per 5 mL | 6 mg elemental iron per mL |
| Ferrous lactate drops | 25 mg/mL | 25 mg elemental iron per mL | 1 mg elemental iron per 0.04 mL |
| Ferrous sulphate compound tablets | 170 mg | ~65 mg elemental iron per tablet | ~65 mg elemental iron per tablet |
The expected response is an increase in Hb of ≥ 2 g/dL in 3 weeks. Continue for 3–4 weeks after Hb is normal to replenish body iron stores. The reticulocyte count will increase if there is a positive response and may be useful where the diagnosis is in doubt, if done within 1–2 weeks after iron therapy is started.
Treat for intestinal helminths
Children 1–2 years of age:
- Mebendazole, oral, 100 mg 12 hourly for 3 days.
Children > 2 years:
- Mebendazole, oral, 500 mg as a single dose immediately.
CAUTION:
Iron is extremely toxic in overdose, particularly in children.
All medication should be stored out of reach of children.
Prophylaxis
All preterm babies, day 15 to 1 year:
- Iron (elemental), oral, 2 mg/kg daily.
- Multivitamin, drops, oral, 0.3 mL daily for formula fed babies.
- Multivitamin, drops, oral, 0.6 mL daily for breastfed babies.
REFERRAL
- Patients not responding to adequate therapy.
- Patients in whom easily treatable causes for non-response have been excluded, e.g.:
- non-adherence to therapy,
- on-going GIT/other blood loss
- on-going infection.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital_2023 edition_Updated February 2025
Chapter 3: Blood and Blood-Forming Organs, 3.4 Anaemia, Iron Deficiency