Etiologies of Iron Deficiency Anemia Secondary to Blood Loss in Children Presenting to a Tertiary Care Setting

Abstract

Background: Iron deficiency anemia (IDA) is the most common type of anemia worldwide, affecting more than 6 million individuals. In children, IDA can impair psychomotor and cognitive development.

Objective: To highlight trends and unique findings related to the etiologies of iron deficiency anemia secondary to blood loss in children presenting to a tertiary care facility.

Method: This was a retrospective chart review study with 91 subjects. Patients were identified using the ICD 10 code D50.0 (iron deficiency anemia secondary to blood loss), and the inclusion criteria were ferritin <15 micrograms/L and hemoglobin <11 g/dL for children 6 months to <5 years and hemoglobin <11.5 g/dL for children 5 to 18 years. Demographic data, baseline and follow up data were collected, and each subject was classified by etiology. Qualitative data were described using frequencies and quantitative data were analyzed using t-tests.

Results: HMB was the most common etiology in 53 (58.3%) subjects, followed by bleeding disorders in 21 (23.1%) subjects, IBD in 8 (8.8%) subjects, H. pylori in 5 (5.5%) subjects, non-IBD GI bleeding in 3 (3.3%) subjects, dietary in 2 (2.2%) subjects, other bleeding in 1 (1.1%) subject and unknown in 4 (4.4%) subjects. There was significant improvement with treatment in follow-up labs, including hemoglobin (p<0.001), MVC (p<0.001), ferritin (p<0.001), serum iron (p=0.005) and transferrin saturation (p<0.001), compared to baseline labs. In patients with heavy menstrual bleeding (HMB) with underlying bleeding disorder had statistically inferior improvement in serum iron (p=0.02) and transferrin saturation (p=0.40). 13.2% of the patients with HMB were diagnosed with a bleeding disorder. 33% of patients had an underlying systemic chronic illness such as IBD or a bleeding disorder.

Conclusions: Pediatric patients presenting to a tertiary care facility with IDA secondary to blood loss receive effective treatment to address the IDA. Bleeding disorders are likely to be under-diagnosed in patients with HMB. It is important to identify bleeding disorders in patients with HMB, because it less likely for IDA to be resolved with treatment.