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Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group

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Abstract

Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.

Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.

What is Known:

• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.

• Significant progress in the diagnosis and therapy of ID has been made over the last decade.

What is New:

• Our expert panel provides ID management recommendations based on the best available evidence.

• They include strategies for ID diagnosis and therapy, both oral and intravenous.

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Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder

ATP:

Adenosine triphosphate

BHS:

Breath-holding spells

CHr:

Reticulocyte hemoglobin content

Hb:

Hemoglobin

IBD:

Inflammatory bowel disease

ID:

Iron deficiency

IDA:

Iron deficiency with anemia

IDWA:

Iron deficiency without anemia

IRIDA:

Iron refractory iron deficiency anemia

IRLSSG:

International Restless Legs Syndrome Study Group

IUGR:

Intra-uterine growth retardation

IV:

Intravenous

LS:

List of specialties (Swiss-approved medicines, FDA/EMA equivalent)

MCV:

Mean corpuscular volume

MCH:

Mean corpuscular/cellular hemoglobin

MCHC:

Mean corpuscular hemoglobin concentration

NHANES:

National health and nutrition examination survey

PLMD:

Periodic limb movement disorder

RBC:

Red blood cells

RDW:

Red cell distribution width

RET-He:

Reticulocyte hemoglobin content

RLS:

Restless legs syndrome

SF:

Serum ferritin

SPOG:

Swiss Pediatric Oncology Group

sTfR:

Serum soluble transferrin receptor

URIDA:

Unexplained refractory iron deficiency anemia

WHO:

World Health Organization

ZnPP:

Zinc protoporphyrin

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Funding

Vifor Pharma SA provided unrestricted support for the three working group meetings to draft this manuscript but had no input in the content of the manuscript and did not influence the discussions at the meetings.

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  1. Veneranda Mattiello and Markus Schmugge contributed equally to the manuscript.

Authors and Affiliations

  1. Department “Woman-Mother-Child and Adolescent”, Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland

    Veneranda Mattiello

  2. Division of Pediatric Hematology, University Children’s Hospital of Zurich, Zurich, Switzerland

    Markus Schmugge

  3. Pediatric Hematology-Oncology Unit, Children’s Hospital of Sankt Gallen, Sankt Gallen, Switzerland

    Heinz Hengartner

  4. Pediatric Hematology-Oncology Department, University Children’s Hospital and University of Basel, Basel, Switzerland

    Nicolas von der Weid

  5. Department “Woman-Mother-Child”, Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Raffaele Renella

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VM, MS, HH, NvdW, and RR reviewed and interpreted the evidence and drafted sections of the manuscript. RR wrote the final manuscript, after comprehensive editing. All authors discussed, reviewed, and agree with the final manuscript.

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Mattiello, V., Schmugge, M., Hengartner, H. et al. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 179, 527–545 (2020). https://doi.org/10.1007/s00431-020-03597-5

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