Looking Behind the Iron Curtain.

Abstract

One of medicine’s greatest strengths is its willingness to reexamine commonly accepted practices. This has been particularly true in the clinical application of screening tests. Frequently, the unsettling controversy that accompanies such reexamination helps shape the improvement that follows. In their article entitled “Screening for Iron Deficiency in Early Childhood by Using Serum Ferritin in the Primary Care Setting,” Oatley et al1 raise a fundamental and likely controversial question about the value of the current practice of measuring the hemoglobin level at 1 year of age. Are we screening for anemia, iron deficiency, or iron deficiency anemia? Only when that question is answered can we rationally choose the right test and the right timing. Current practice, as recommended by the American Academy of Pediatrics, is to test for anemia, either with a complete blood count test or a dedicated hemoglobin analyzer, with further testing before or after iron replacement if the hemoglobin level is <11.2 The problem, however, is that the … Address correspondence to Alan R. Cohen, MD, Children’s Hospital of Philadelphia, Abramson Research Center, Room 1416, 3615 Civic Center Blvd, Philadelphia, PA 19104. E-mail: cohen{at}email.chop.edu