Nutritional Iron Deficiency Anemia Research Articles

Retracted: Changes of Serum Ferritin, Hemoglobin, and Serum Iron (SI) and Treatment Effect of Iron Proteinsuccinylate Oral Solution Combined with Vitamin A and D Drops on Children with Nutritional Iron Deficiency Anemia.

[This retracts the article DOI: 10.1155/2022/2972617.].

A case report on the use of Ayurveda in the treatment of Iron Deficiency Anaemia

Among pregnant women and young children, nutritional iron deficiency anaemia is a worldwide public health concern and the leading cause of anaemia. Iron deficiency anaemia is often caused by blood loss or mal-absorption. Iron deficiency anaemia and Pandu Roga are very similar clinical entities. Pitta Pradhan Vyadhi is Pandu Roga. The vitiated Doshas in Pandu Roga cause a disruption in tissue metabolism, which results in Dhatu-Shathilya in all of Dhatu. Paleness is the dominant colour across the body. The Rasavaha and Raktavaha Srotasas play a significant role in the development of Pandu. In this case study, we see a 22-year-old female patient with iron deficiency anaemia who, after a month of treatment with Ayurvedic formulations in the Pandu Roga line of treatment and iron-rich dietary supplements, experienced a dramatic improvement in her symptoms (less swelling, no pallor, increased energy, decreased palpitation, and hair loss of 10 strands per day) and an increase in her haemoglobin level (from 8.6g/dl to 12.7g/dl) at a very rapid pace. The Samprapti of Pandu Roga may be broken with the aid of the formulas. Iron deficiency anaemia (Pandu) may be effectively treated with Ayurvedic medication.

Diagnostic Utility of Bone Marrow Aspiration Cytology- A Hospital Based Prospective Study at Nepalgunj Medical College

Introduction: Hematological disorders are common in all age groups and are worldwide in distribution. At times, routine hematological tests are not sufficient to diagnose blood disorders. Bone marrow examination serves as an important diagnostic aid to evaluate various neoplastic and non-neoplastic hematological diseases.
 Aims: To study role of Bone Marrow Aspiration Cytology in diagnosing hematological disorders. 
 Methods: This is a one-year hospital based prospective study done at Department of Pathology, NGMC, Kohalpur. It included 34 cases subjected to Bone marrow aspiration cytology. Correlation with Peripheral Blood Smear, Reticulocyte count, pearls iron stain and other parameters were done before giving the final diagnosis.
 Results: Age of patients ranged from 10-82 years with equal gender distribution. Common indications for Bone marrow examination were pancytopenia (50%), followed by Anemia and Thrombocytopenia. Megaloblastic Anemia (n=10,29%) was the commonest Anemia followed by mixed nutritional deficiency and Iron Deficiency Anemia. Hematological Malignancy accounted for six cases, of which Acute Myeloid Leukemia was diagnosed in two cases. Infectious causes comprised of two cases of Visceral Leishmaniasis and one case of Bone Marrow Tuberculosis.
 Conclusion: Bone marrow aspiration cytology serves as an important adjunct in diagnosing hematological disorders. More reproducible results are obtained if bone marrow biopsy is done in conjucntion with aspiration cytology.

Severe iron deficiency anemia with critically low hemoglobin in a 2-year-old child: a case report

Background: Anemia in young children is a major public health problem worldwide. Around 1.6 million people have been diagnosed with anemia, and 47.4% of them are preschool children. Nutritional Iron Deficiency Anemia (IDA) is the most common type of anemia in pediatrics. Several complications happen due to IDA during the first 2 years of life, such as reducing cognitive development, lowering immunity, and delaying growth. Case Presentation: A 2-year-old girl was brought to the Emergency Room complaining of fever (39°C) associated with skin pallor for 2 months. A complete blood count laboratory test result showed a very critical low hemoglobin (Hb) 3.39 g/dL. She received a blood transfusion, as a life-saving treatment. She was diagnosed with IDA secondary to formula milk dependency. Her Hb reached 10.62 g/dL and she was discharged with iron supplementation for 6 months. Conclusion: This case adds more to the literature by documenting critically low Hb level with positive findings in physical examination, which are pansystolic murmur and palpable bounding pulse, indicating severe IDA.

Management of nutritional iron deficiency anemia for young children in the emergency department.

Guidelines for young children with nutritional iron deficiency anemia (IDA) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize management of these patients through the development and implementation of an evidence-based algorithm using quality improvement methodology. Baseline data of the target population (n=42; 60% male; median age 22.5 months, median hemoglobin 5.3g/dl) identified variability across four key measures of clinical management: laboratory evaluation, therapy choice, therapy administration, and patient disposition. Literature review and consensus from pediatric hematology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From September 2020 to June 2021, we aimed to increase IDA management per the algorithm by ≥20% relative to baseline for the four key outcome measures using sequential Plan-Do-Study-Act (PDSA) cycles. Process measures focusing on provider communication/documentation and balancing measures involving efficiency and therapy-related adverse events were assessed concurrently. Thirty-five patients were evaluated among four PDSA cycles and shared similar characteristics as the baseline population. Improvements of ≥20% above baseline adherence levels or 100% adherence were achieved for all outcome measure across four PDSA cycles. Adherence to recommended laboratory evaluation improved from 43 (baseline) to 71%, therapy choice from 78 to 100%, therapy administration from 50 to 83%, and disposition from 85 to 100%. ED length of stay remained stable. Implementation of a standardized algorithm for young children with nutritional IDA in the ED increased adherence to evidence-based patient care.

Severe iron deficiency anemia in the paediatric emergency department: A retrospective study.

Transfusion is discouraged in hemodynamically stable children with severe iron deficiency anemia (IDA). Intravenous (IV) iron sucrose (IS) could be an alternative for some patients; however, there is a paucity of data on its use in the paediatric emergency department (ED). We analyzed patients presenting with severe IDA at the Children's Hospital of Eastern Ontario (CHEO) ED between September 1, 2017, and June 1, 2021. We defined severe IDA as microcytic anemia <70 g/L and either a ferritin <12 ng/mL or a documented clinical diagnosis. Of 57 patients, 34 (59%) presented with nutritional IDA and 16 (28%) presented with IDA secondary to menstrual bleeding. Fifty-five (95%) patients received oral iron. Thirteen (23%) patients additionally received IS and after 2 weeks, the average Hgb was similar to transfused patients. The median time for patients receiving IS without PRBC transfusion to increase their Hgb by at least 20 g/L was 7 days (95%CI 0.7 to 10.5 days). Of 16 (28%) children who were transfused with PRBC, there were three mild reactions, and one patient who developed transfusion associated circulatory overload (TACO). There were two mild and no severe reactions to IV iron. There were no return visits to the ED due to anemia in the following 30 days. Management of severe IDA with IS was associated with a rapid rise in Hgb without severe reactions or returns to ED. This study highlights a strategy for management of severe IDA in hemodynamically stable children that spares them the risks associated with PRBC transfusion. Paediatric specific guidelines and prospective studies are needed to guide the use of IV iron in this population.

80 To Transfuse or Not to Transfuse: Choosing blood transfusions wisely in young children hospitalized with iron deficiency anemia

Abstract Background Nutritional iron deficiency anemia (IDA) peaks in prevalence at 6to 36 months of age. Children with severe IDA often present to emergency departments and may be hospitalized. Currently, little is known about the management and use of packed red blood cell transfusion in hospitalized children with severe IDA. The current Canadian Paediatric Society (CPS) Practice Point on iron requirements in the first 2 years of life (February 2021) provides guidance on prevention of iron deficiency and iron therapy; however, there is no guidance on the use of blood transfusion in children with severe IDA. Choosing Wisely Canada provides guidance on blood transfusions for adults; however, there are no recommendations on transfusion in children. In contrast, the joint American Society of Hematology and American Society of Pediatric Hematology/Oncology Choosing Wisely Task Force recently published (January 2022) recommendations, including avoiding packed red blood cell transfusion for asymptomatic children with IDA and no active bleeding. Objectives To describe the rate of blood transfusion and characteristics of young children hospitalized with IDA. Design/Methods Data from children, 6 to 36 months, hospitalized with IDA (2001-2020) was abstracted from health records using a standardized data collection form. Eligibility criteria were discharge diagnosis of IDA according to International Classification of Diseases codes, and laboratory evidence of IDA (hemoglobin &amp;lt; 110 g/L and at least two abnormal markers such as MCV, ferritin, transferrin, iron). Descriptive statistics were used. Results Of 79 children hospitalized with nutritional IDA (mean age 18.5 months), 34 (43%) received a blood transfusion. Of those receiving a transfusion, the initial mean hemoglobin was 32g/L (range 17-56g/L). Volume of blood given was: 5mL/kg (n=23, 68%), 10mL/kg (n=8, 23%), and &amp;gt;10mL/kg (n=3, 9%). Two children experienced adverse reactions: allergic reaction; non-hemolytic transfusion reaction. Characteristics of the entire cohort (n=79) were: female (n=51, 65%); previously healthy (n=69, 87%); received iron therapy prior to hospitalization (n=6, 8%); tachycardia on presentation (n=47, 59%); daily milk intake (mean 1638mL, range 236-9000mL). Initial laboratory results (mean) were: hemoglobin 40g/L (range 15-85g/L); MCV 51fL; platelet count 574x109/L; ferritin 3ug/L. Management included dietitian consultation with recommendation to reduce milk intake (n=69, 87%) and all patients received oral iron therapy on discharge (n=79, 100%). No child received intravenous iron therapy during their admission. Conclusion Our findings suggest high rates of blood transfusion among young children hospitalized with iron deficiency anemia. Future research includes examining factors associated with transfusion and practices at other Canadian centres. Our overall aim is to help inform future CPS and Choosing Wisely Canada recommendations.

Iron Deficiency Anemia in Pregnancy.

Through its functions in oxygen delivery, electron transport, and enzymatic activity, iron is crucial for the operation of all cells. High metabolic rate cells need more iron and are more likely to malfunction when there is an iron deficit. Since the mother's blood volume expands during pregnancy, and the fetus grows and develops, there is a sharp increase in the need for iron. Negative pregnancy outcomes, such as increased maternal sickness, low birthweight, preterm, and intrauterine growth restriction, are linked to iron deficiency. IDA, or nutritional iron deficiency anemia, affects more than two billion people worldwide and is the most prevalent disease. Based on the regression-based analysis, the prevalence of anemia in the World Health Organization's global database was calculated to be 14%. According to recent data, there are 17.4% more IDA cases among pregnant women in industrialized countries than in poor ones (up to 56% more cases). Despite the fact that oral iron supplementation is frequently used to treat IDA, not all patients benefit from oral iron therapy. This is caused by a number of things, which include the adverse effects of oral iron, resulting in low compliance and ineffectiveness. In a sizable group of patients taking oral iron preparations, the adverse effects primarily include GI symptoms. Intravenous iron was previously underutilized since it was linked to unfavorable and occasionally dangerous side effects. New type II and III iron complexes have been created recently, though, and they offer superior compliance and toleration in addition to strong efficacy and a good safety profile.

Maternal nutritional awareness and iron deficiency anemia in children aged 6 months–2 years in a tertiary care hospital in Coimbatore, Tamil Nadu

Objective: This study aims to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: A hospital-based cross-sectional study done in Coimbatore for 2 years. Using a pre-tested structured validated tool, mothers of children aged 6 months–2 years were interviewed to collect information on factors contributing to anemia with special regard to maternal knowledge. Results: Anemia was more in the latter half of infancy (67.2%) with male predominance (60.5%). An affirmative association between increased cow’s milk intake and low hemoglobin was present (p=0.002). Employed and less educated mothers had more anemic children (p&lt;0.05). Of 16% mothers classified as “poor” awareness, 95.45% children had low hemoglobin (p&lt;0.05). Conclusion: Recognizing the causative factors plays an essential role in preventing iron deficiency anemia (IDA). Exclusive breastfeeding must be promoted, along with avoiding excessive cow’s milk intake. Intervening at the right period with age-appropriate foods becomes a necessity. Maternal illiteracy has a positive correlation with anemia in infants. Improving maternal awareness by the physicians will pave the road toward a nation free from anemia.

Ayurveda in Management of Iron Deficiency Anemia: A Case Report

Nutritional iron deficiency anemia is the most common cause of anemia and a global public health problem among young children and pregnant women. Blood loss, malabsorption is the common cause of iron deficiency anemia. Pandu roga is a clinical entity with great resemblance to iron deficiency anemia. Pandu roga is Pitta pradhan vyadhi. In Pandu roga tissue metabolism gets affected due to vitiated Doshas which in turn into Dhatu- shyathilya in all Dhatu. There is a predominance of paleness all over the body. Rasavaha and Raktavahasrotasas are chiefly involved in the pathogenesis of Pandu. So, here is a case report of 21 years old female patient with iron deficiency anemia who was given Ayurvedic formulations in the line of treatment of Pandu roga along with dietary supplements rich in iron for a period of one month and marked improvement in symptoms (i.e., swelling was reduced, pallor absent, she was feeling energetic, hair fall (10 strands/day), palpitation had also decreased) with increase in hemoglobin level (i.e., from 8.6g/dl to 12.7g/dl) in a very short duration of time. The formulations help in breaking the Samprapti of Pandu roga. This shows the efficacy of Ayurvedic medicine in the treatment of iron deficiency anemia (Pandu).

Changes of Serum Ferritin, Hemoglobin, and Serum Iron (SI) and Treatment Effect of Iron Proteinsuccinylate Oral Solution Combined with Vitamin A and D Drops on Children with Nutritional Iron Deficiency Anemia.

Objective The purpose was to evaluate the treatment effect of iron proteinsuccinylate oral solution combined with vitamin A and D drops on children with nutritional iron deficiency anemia. Methods 124 children treated in the outpatient department of our hospital from January 2017 to January 2020 were selected as the study subjects. They were randomly divided into control and observation two groups. The control group was treated with iron proteinsuccinylate oral solution (1.5 mL/kg) in the morning and evening, respectively. The observation group received adjuvant treatment with oral vitamin A and D drops based on the treatment of the control group. The treatment effect of proteinsuccinylate oral solution combined with vitamin A and D drops was evaluated by the serum iron (SI), serum ferritin (SF), and transferrin (TRF) levels, the values of CD3+, CD4+, and CD4+/CD8+, and other evaluation indicators. Results After treatment, the SI and SF levels of children in both groups significantly increased (P < 0.01) while the TRF level significantly decreased (P < 0.01), and the SI and SF levels in the observation group increased more significantly, and the TRF level decreased more significantly compared with those in the control group (P < 0.01). After treatment, the values of CD3+, CD4+, and CD4+/CD8+ of children in both groups significantly increased compared with those before treatment (P < 0.01), and the values of CD3+, CD4+, and CD4+/CD8+ increased more significantly in the observation group compared with those in the control group (P < 0.01). In addition, the evaluation results of treatment effect showed that the markedly effective rate in the observation group was significantly higher than that in the control group (P < 0.01). Conclusion Iron proteinsuccinylate oral solution combined with vitamin A and D drops can better improve the anemia symptoms in children, with high application value.

Iron deficiency anaemia in pregnancy and its prevention; paradigm changes over three decades

In Sri Lanka, the prevalence of anaemia in pregnancy was estimated to be approximately 29% in 2001 but is estimated to have significantly reduced to be &lt; 20%, at least in certain areas, during the last decade. Among its many causes, nutritional iron deficiency anaemia (IDA) is the commonest, but establishing a definitive diagnosis is difficult. Strategies adopted globally, as well as in Sri Lanka, to prevent IDA in pregnancy, have changed significantly during the last three decades. A comprehensive literature review was carried out and inter alia three relevant World Health Organization Guidelines, in which the author was a member of the guideline development group and six other publications of the author, on the topic of iron deficiency (ID) and IDA in pregnancy are included in this review. Ten studies on the detection and prevention of ID and IDA in pregnancy, carried out from 1990 to 2017 at the Academic Obstetrics and Gynaecology Unit (AOGU) of the Teaching Hospital Mahamodera, Galle (THMG) are described. The results and conclusions of these studies were: poor compliance and unsatisfactory methods of ingestion of the antenatal oral iron supplement could have contributed to the high rates of ID and IDA at term during the period 1990 to 1992; haematological indices during pregnancy need to be interpreted with caution; although the agreement between haematological indices obtained from different laboratories in Galle in 2000 was unsatisfactory, better agreement was observed in 2015; the rates of ID and IDA in pregnant women presenting for antenatal care to the AOGU of the THMG have significantly decreased from approximately 69% and 44% respectively in 1990 to approximately 37% and 17% respectively in 2015. Therefore, weekly antenatal oral iron supplements should be adequate to improve birth outcomes in the non-anaemic women attending this clinic.

Caregiver-Perceived Facilitators and Barriers to Oral Iron Therapy in Young Children with Iron Deficiency Anemia

BackgroundIn the U.S., 2 to 3% of children age 1 to 3 years are affected by nutritional iron deficiency anemia (IDA). Children of Hispanic/Latino ethnicity are disproportionately affected and have rates approximately double that of other racial and ethnic groups. IDA is associated with inferior neurodevelopmental outcomes, poorer executive functioning, and decreased visual and auditory processing time. Treatment with oral iron mitigates against the consequences of IDA. Non-adherence to oral iron often results in treatment failure, and incomplete therapy prolongs the extent of IDA consequences. We aim to characterize barriers to and facilitators of oral iron therapy in young children with nutritional IDA.MethodsInfants and children aged 9 months to 4 years (all racial and ethnic groups) with nutritional IDA (assessed by history and laboratory criteria) and treated with oral iron therapy in the outpatient hematology clinic at a large US tertiary care pediatric hospital are identified. English or Spanish-speaking caregivers of identified children are invited to participate with the goal of conducting half the interviews in each language. In person audio-recorded semi-structured interviews are conducted by a research coordinator trained in qualitative methods using an IDA interview guide developed by a multidisciplinary research team. The guide is divided into 6 broad categories: diagnosis, consequences, experience with oral iron therapy (barriers to and facilitators of adherence), motivation, and alternate treatment options. For Spanish-speaking caregivers, an in-person Spanish interpreter assists with the interview.Verbatim transcripts are reviewed manually by 2 members of the research team to perform thematic analysis and identify common patterns in responses. Interviews and qualitative analysis will continue until thematic saturation is achieved (i.e. no new themes emerge from subsequent interviews). Clinical data, including laboratory values and treatment regimen, are abstracted from the patient's electronic medical record. Here we present findings from the initial six months of the study (February to July 2017).ResultsNine caregivers to date have been approached, and all enrolled. Patients had a mean age of 20 months (range 12 to 32 months); 5 (55%) were male. Nine caregiver interviews were completed; six in English and three in Spanish. All caregivers self-identified as White and Hispanic/Latino. Median hemoglobin concentration at patients' first visit within the hematology clinic was 8.6 g/dL (range 5.4 to 10.4 g/dL). Median duration of oral iron therapy at the time of interview was 4 months (range 2 to 10 months).Caregivers expressed a range of emotions that included fear and anxiety at time of diagnosis and optimism with treatment resolution. Many stated desire to have received information on risk factors and prevention of iron deficiency prior to their child's development of IDA. Regarding the diagnosis of IDA, most caregivers had a basic understanding of the condition, though some misinformation was present. Widely variable consequences of IDA were described, which included: changes in skin color, decreased energy, and potential for more severe disease if undetected. Negative traits of iron therapy, specifically poor taste and difficulty in getting child to take the medication, were barriers. Transition to better tasting formulations overcame these barriers for some families. When presented with information on intravenous iron therapy, most caregivers demonstrated willingness for their child to receive it if oral iron failed. Most caregivers deferred treatment-related decision-making to the recommendation of the physician.ConclusionCaregiver-perceived barriers to oral iron adherence were poor taste and difficulty in getting the child to take the medication. Knowledge regarding the diagnosis of IDA was not a consistent barrier as most caregivers reported a basic understanding of the condition. Specific caregiver-identified motivating factors and facilitators to oral iron adherence have not yet been elucidated. Additional, more targeted qualitative interviews with caregivers will be performed to elicit such information. These results will inform future patient-centered interventions aimed at promoting treatment in children with IDA. DisclosuresNo relevant conflicts of interest to declare.

Incidence of Anemia in the Population of Dir (Lower) Khyber Pakhtunkhwa

Introduction: Iron deficiency anemia is one of the major global public health issue causes many serious diseases mostly found in the women and children of developing world.&#x0D; Objective: To evaluate and assess the occurrence and disorder related to iron deficiency in the population of district Dir (Lower).&#x0D; Materials and Methods: From all volunteers blood samples were collected from Vein through syringe and kept it in the EDTA tubes. Hemoglobin concentration was determined by the help of Hematology Analyzer. Following the guidelines of WHO, the value of a hemoglobin (Hb) was &lt;11.5 gm/dl the cut-off for anemia. Data were analyzed by using SPSS.&#x0D; Results: Overall 200 participants were examined of whom n=80 (40%) were anemic which was found higher in age 1-20 years n= 31 (15.5%), farmers n=28 (14%) and house wives n=20 (10%) and malaria patients n=7 (3.5%). While in gender wise study males n=57 (28.5%) were found more anemic than females n=23 (11.5%) P-value (0.95).&#x0D; Conclusions: Awareness and education in public about iron deficiency anemia, its causes and related disorder can prevent anemia of iron deficiency. Knowledge about nutritional requirements and iron deficiency anemia in women can save children and whole family from many diseases like anemia. So knowledge, education and awareness in population especially in women are very necessary.

Compliance and Efficacy of Oral Lactoferrin versus Ferrous Sulfate in Treatment of Nutritional Iron Deficiency Anemia during Second Trimester among Egyptian Ladies

Background: Nutritional iron deficiency anemia is of a major concern in Egypt, especially during pregnancy. The most commonly used treatment is oral iron mainly as ferrous sulfate. Unfortunately, ferrous sulfate has low efficacy with many adverse effects. Lactoferrin is a glycoprotein which belongs to proteins which have the ability to bind and transfer iron. This study was done to assess the compliance, efficacy and safety of lactoferrin in comparison to ferrous sulfate. Methods: This randomized clinical trial was conducted in outpatient clinic under supervision of Department of Obstetrics and Gynecology, Faculty of medicine, Ain Shams University, Cairo, Egypt from August 2019 to February 2020. 140 women with iron deficiency anemia in second trimester were recruited and randomly assigned to either group. First group received lactoferrin 200 mg sachets once daily and second group received 100 mg of dried ferrous sulfate capsules twice daily for 4 consecutive weeks. Compliance to treatment, efficacy and side effects were recorded. Results: Compliance is better in lactoferrin group in comparison to ferrous sulfate group. Maternal side effects were significantly less common in lactoferrin group than in ferrous sulfate group. The increase in hemoglobin was significantly higher in lactoferrin group. Number of cases achieved Hb level ≥10.5 was more frequent in lactoferrin group. Conclusion: Oral lactoferrin is more tolerated and effective as compared to traditional treatment by ferrous sulfate.

Prevalence of nutritional iron deficiency anemia among children under six years in Al Madinah, Basra, Iraq

Prevalence of nutritional iron deficiency anemia among children under six years in Al Madinah, Basra, Iraq

A Study Examining the Efficacy of Ferric Carboxymaltose in a Large Pediatric Cohort

Background: Iron deficiency anemia (IDA) is common in the pediatric population with high risk factors such as nutritional deficiency, inflammatory bowel disease (IBD) and other bowel inflammatory disorders, menorrhagia, blood loss, poor absorption and anemia of chronic disease. Intravenous (IV) iron supplementation has become a more desirable mode of treatment in patients with moderate to severe anemia and in patients who are either unresponsive to or have undesirable side-effects secondary to oral iron. Iron sucrose and Iron dextran have been traditionally used in pediatrics as they both are FDA approved for use in this population. Ferric carboxymaltose (FCM) has only been FDA approved for use in adults however is currently used in pediatrics as well. One of the major advantages of Ferric carboxymaltose is the ease of dosing and efficacy. Though FCM was approved for adults in 2013 and there have been no safety concerns, it is not yet FDA approved for pediatric patients despite a few pediatric studies demonstrating its safety and efficacy (Laass, et al., 2014; Powers et al., 2017; Tan et al., 2017, Carman et al., 2019). The purpose of this study is to examine the utilization of different IV iron formulations in a large pediatric hospital as well as evaluate the safety and efficacy of ferric carboxymaltose in comparison to other IV iron formulations. At this time, we present data regarding the use of different forms of IV iron. Methods: This is a retrospective chart review study of all patients who met inclusion criteria in a large pediatric hospital who received Iron dextran, Iron sucrose, and/or FCM between the dates of 8/1/2018 through 9/30/2019. Anonymized data from eligible patients was entered into a secure electronic database. Once our population of interest was isolated, based on the proposed criteria, we reviewed charts individually and collected data including demographics and details about each IV iron administration. Demographic data encompassed race and gender. We also recorded the patients' underlying diagnosis (or diagnoses) contributing to iron deficiency anemia. In addition to compiling demographic data, we also wanted to analyze the trend of IV iron usage in our institution. This was done by tallying the number of each type of IV iron infusion monthly for the allotted time period. Results: A total of 120 patients met inclusion criteria and were included in this study with details regarding diagnosis in Figure 1. Fifty-six (46.7%) patients were male and 64 (53.3%) were female. We also analyzed the underlying diagnoses leading to IDA of patients who received IV iron infusions. Most patients had an underlying IBD diagnosis (Crohn's Disease 49.2%, Ulcerative colitis 15.8%, and Indeterminate colitis 5.8% of all included patients). Additional diagnoses included 18 patients (15%) with nutritional IDA and 8 patients (6.7%) with heavy menses. Examples of "other" diagnoses are blood loss secondary to immune thrombocytopenia, short bowel secondary to complex gastroschisis, gastrointestinal bleed secondary to Helicobacter pylori, short bowel secondary to bowel resection due to graft versus host disease after hematopoietic stem cell transplant, TMPRSS6 mutation, protein losing enteropathy, short bowel secondary to midgut volvulus and intestinal atresia, among other diagnoses. We also analyzed the overall usage of IV iron in our institution during this same time period. The number of IV iron infusions has steadily increased since August 2018. The average number of IV iron infusions was 18 per month in 2018 and 22.67 per month in 2019. As shown in figure 3, the utilization of iron dextran has decreased over time. The graph also displays that the usage of FCM at our institution continues to increase as time progresses. Conclusion: Analysis of demographic data reveals that an underlying gastrointestinal diagnosis is the most common reason for receiving IV iron likely due to decreased absorption of enteral iron. Our data has also shown that the overall usage of IV iron is increasing in the pediatric population as well as specifically FCM. This study is the first retrospective pediatric review comparing the utilization of different IV iron formulations including FCM. Preliminary data demonstrates an increase in hemoglobin after treatment with FCM, however further analysis of the data is ongoing. Figure 1 Disclosures No relevant conflicts of interest to declare.

The Effect of Anemia Free Club Interventions to Improve Knowledge and Attitude of Nutritional Iron Deficiency Anemia Prevention among Adolescent Schoolgirls in Bandar Lampung City, Indonesia

BACKGROUND: Anemia in adolescent is a global public health problem affecting both developing and developed countries. Adolescents are at high risk of anemia. School-based interventions are important to decrease the anemia.&#x0D; AIM: This study was performed to determine the effect of anemia free club interventions to improve knowledge and attitude of nutritional iron deficiency anemia prevention among adolescent schoolgirls in Bandar Lampung City, Indonesia.&#x0D; METHODS: The authors conducted a quasi-experimental. The study sample consists of 55 intervention groups and 47 control groups of senior high schoolgirls in Bandar Lampung City. The intervention group attended nutrition education–based, namely, anemia free club sessions for 12 weeks, while the control group did not. The sampling technique is proportional random sampling. Before and after the intervention program, knowledge and attitude questionnaire were filled out for both the groups. A paired sample t-test was used for data analysis. p &lt; 0.05 was considered as statistically significant effect. Finally, data were collected and analyzed by the SPSS program.&#x0D; RESULTS: This study known before the intervention, there were no significant differences regarding the knowledge and attitude in two groups (p &gt; 0.05). After the intervention, there were significant differences in the levels of knowledge and attitude between intervention and control groups (p &lt; 0.05).&#x0D; CONCLUSION: This analysis confirmed an effect of anemia free club interventions to improve knowledge and attitude of nutritional iron deficiency anemia prevention among adolescent schoolgirls.

Barriers to and Facilitators of Iron Therapy in Children with Iron Deficiency Anemia

To characterize barriers to and facilitators of successful iron therapy in young children with iron deficiency anemia (IDA) from an in-depth parental perspective. Prospective, mixed methods study of children age 9months to 4years with a diagnosis of nutritional IDA by clinical history and laboratory criteria and their parents. Clinical data were obtained from the electronic health record. Semistructured interviews focused on knowledge of IDA, clinical effects, experience with iron therapies, and motivation were conducted with the parent who identified as the child's primary caregiver. Twenty patient-parent dyads completed the study; 80% (n=16) identified as Hispanic/Latino (white). Patients' median age was 23months (50% male); median initial hemoglobin concentration was 8.2g/dL and duration of oral iron therapy was 3months. Parents' median age was 29years (85% female); 8 interviews (40%) were conducted in Spanish. Barriers included difficulty in administering oral iron owing to side effects and poor taste. Facilitators included provision of specific instructions; support from healthcare providers and additional caregivers at home; motivation to benefit child's health, which was strengthened by strong emotional reactions (ie, stress, anxiety) to therapy and follow-up; and an appreciation of child's improvement with successful completion of therapy. Our findings support the need for interventions designed to promote oral iron adherence in children with IDA. Rather than focusing on knowledge content related to IDA, interventions should aim to increase parental motivation by emphasizing the health benefits of adhering to iron therapy and avoiding more invasive interventions.

The effect of therapy on plasma ghrelin and leptin levels, and appetite in children with iron deficiency anemia.

Background It is known that iron deficiency anemia effects appetite and growth negatively. The aim of this study was to investigate the effect of iron therapy on appetite, growth and plasma ghrelin and leptin levels in children aged between 12 and 24 months with isolated nutritional iron deficiency anemia. Methods Iron deficiency anemia was diagnosed by clinic and laboratory findings. All 19 cases were given 5 mg/kg/day iron therapy for 3 months. Results The mean plasma ghrelin level was 936.7±428.8 pg/mL before therapy and it increased to 1284.7±533.3 pg/mL (p<0.001) while the mean plasma leptin level decreased from 3.4±1.6 ng/mL to 1.9±1.0 ng/mL (p<0.01) after therapy. The amount of daily caloric intake, carbohydrate and protein intake were significantly increased after therapy (p<0.001). Δ body weight was correlated with plasma ghrelin levels before and after therapy significantly. Conclusions In conclusion, the findings of this study indicate that plasma ghrelin level increases and leptin level decreases and growth accelerates because of an increase in appetite and daily calories, carbohydrate and protein amount in children with nutritional iron deficiency anemia after iron therapy. The increase in appetite and acceleration on growth in iron deficiency anemia might result from decreased leptin and increased plasma ghrelin levels. The most important finding of this study is significantly increased plasma ghrelin levels after iron therapy, and this finding might be related to both the improved appetite and catch-up growth.