P2.C054: Severe Iron Deficiency Anemia in the Pediatric Intensive Care Unit: Experience from a Community-based Hospital

Background: Despite recommendations for routine screening for iron deficiency anemia (IDA) in children, hospital-based clinicians continue to encounter severe IDA in children. Objectives of the current study were to describe the characteristics of severe IDA in children admitted to a community-based pediatric intensive care unit (PICU) and to evaluate the correlation between the level of hemoglobin (Hb) and exposure to the number of units of packed red blood cells transfused.

Methods: Records of children admitted to the PICU with a hemoglobin level of less than 5 grams (g)/dL and low serum iron levels were reviewed, and the following data were tabulated: age, gender, race, initial hemoglobin (Hgb), mean corpuscular volume (MCV), red cell distribution width (RDW), reticulocyte count, platelet count, serum iron and ferritin level. The lowest hemoglobin recorded was 1.4 g/dL. All patients received PRBC transfusions in aliquots of 5-10 mL/kg over one hour, and the number of units of PRBC used in each patient was recorded.

Results: Thirteen children (4 male, 9 female) with IDA from July 1, 2018, through June 30, 2023, were identified, with a median age of 2.2 years (IQR: 1.7-8.4) and a mean initial Hgb of 3.4 ± 1.2 g/dL. Five children were white, five were African American, one was Hispanic, and two were of other races. The initial MCV was reduced to 58 ± 7, and initial serum iron and ferritin levels were low at 10 ± 10 μg/dL and 3.5 ± 1.2 μg/mL, respectively. There was a negative correlation between the level of initial Hgb and exposure to the number of units of PRBC utilized for transfusion during hospitalization (r = -0.44, p < 0.05).

Conclusion: Severe IDA is still recognized in children and requires admission to the hospital. The lower the hemoglobin level, the higher the probability of exposure to more units of PRBCs transfused.