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Cohen CT, Powers JM. Intravenous iron therapy in pediatrics: who should get it and when is the right time? Hematology Am Soc Hematol Educ Program 2023; 2023:630-635. [PMID: 38066925 PMCID: PMC10727076 DOI: 10.1182/hematology.2023000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Iron-deficiency anemia occurs most commonly in young children due to a low-iron diet and adolescent girls due to menstrual blood loss. However, children with gastrointestinal conditions such as intestinal failure, inflammatory bowel disease, celiac disease, and/or other chronic conditions, including chronic kidney disease and heart failure, also commonly have iron deficiency. Many patients with classic iron-deficiency anemia will improve with oral iron therapy. However, in children who have an incomplete response to oral iron, intravenous iron therapy is increasingly being used. Benefits of intravenous iron therapy include a rapid repletion of iron stores in addition to resolution of anemia, less gastrointestinal side effects, and relief for patients and families struggling with long-term iron supplementation. Indications for first-line therapy with intravenous iron in children with chronic conditions have also increased. Four intravenous iron formulations have approved indications in pediatrics, and many are increasingly used off-label in children as well. Here we discuss the indications and appropriate timing of intravenous iron therapy in children with a wide range of underlying etiologies.
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Affiliation(s)
- Clay T Cohen
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer and Hematology Center, Houston, TX
| | - Jacquelyn M Powers
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer and Hematology Center, Houston, TX
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Gonzalez VB, Hanna I, Shah CC, Koul PB. Iron Deficiency Anemia Presenting as Ischemic Stroke in Pediatric Patient. Clin Pediatr (Phila) 2023:99228231199835. [PMID: 37735889 DOI: 10.1177/00099228231199835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Vincent B Gonzalez
- Department of Pediatrics, University of Florida Health, Jacksonville, FL, USA
| | - Issa Hanna
- Division of Pediatric Emergency Medicine, University of Florida Health, Jacksonville, FL, USA
| | - Chetan C Shah
- Division of Pediatric Radiology, Nemours Children's Health, Jacksonville, FL, USA
| | - Pulin B Koul
- Pediatric Emergency Medicine, Wolfson Children's Hospital, Jacksonville, FL, USA
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McEvoy MT, Stuckert AJ, Castellanos MI, Gilbert MM, Pfeiffer T, Prudowsky Z, Rios X, Airewele G, Okcu MF, Powers JM. Management of nutritional iron deficiency anemia for young children in the emergency department. Pediatr Blood Cancer 2023; 70:e30181. [PMID: 36579803 DOI: 10.1002/pbc.30181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND 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. PROCEDURE Baseline data of the target population (n = 42; 60% male; median age 22.5 months, median hemoglobin 5.3 g/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. RESULTS 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. CONCLUSIONS Implementation of a standardized algorithm for young children with nutritional IDA in the ED increased adherence to evidence-based patient care.
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Affiliation(s)
- Matthew T McEvoy
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Austin J Stuckert
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Maria I Castellanos
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA.,UCSF Benioff Children's Hospitals, Department of Pediatrics, San Francisco/Oakland, California, USA
| | - Megan M Gilbert
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas Pfeiffer
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA.,St. Louis Children's Hospital, Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Zachary Prudowsky
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Xavier Rios
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Gladstone Airewele
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - M Fatih Okcu
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Jacquelyn M Powers
- Texas Children's Hospital, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
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