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Iron-deficiency anaemia in children
Iron-deficiency anaemia is the commonest anaemia in children, mainly at 6–24 months and in adolescent girls; the diagnosis rests on a microcytic anaemia with low ferritin, and the best diagnostic test is the response to iron.
Why it matters in the exam
The classic exam story: a pale toddler of eighteen months who drinks large amounts of cow's milk and eats few solids. The questions ask for the cause (cow's milk is rich in calcium and poor in iron, displaces food, and sometimes causes occult gut bleeding), the test (blood count, ferritin) and the treatment. A parallel question asks to separate it from thalassaemia trait: there the RDW is normal, the red-cell count is relatively high and the Mentzer index is below 13.
Treatment follow-up is asked just as often: reticulocytes rise within days, haemoglobin rises by at least a gram within 4 weeks, and treatment continues for 3 months after the haemoglobin is normal to refill the stores. When there is no response, check adherence, ongoing bleeding, coeliac disease, and a wrong diagnosis. For prevention: limit cow's milk, avoid cow's milk before one year, and give infants an iron supplement according to the Ministry of Health (Tipat Halav) recommendations.
Iron deficiency harms more than the haemoglobin: in toddlers it is linked to developmental delay and impaired attention, so deficiency even without anaemia deserves treatment. Further risk groups are preterm babies, babies born with low birth weight, children with gut diseases such as coeliac disease and IBD, and adolescent girls with heavy periods. A child with pica, meaning eating non-food substances, should be tested both for iron deficiency and for lead exposure. Blood transfusion remains reserved for severe anaemia with signs of heart failure.
Key points
- The commonest in children: age 6–24 months and adolescent girls.
- Large amounts of cow's milk are the classic cause in a toddler.
- Low MCV, high RDW, low ferritin; Mentzer above 13.
- Iron 3 mg/kg per day; response = a rise of at least 1 g/dL within 4 weeks.
- Continue for 3 months after the haemoglobin normalises.
Summary table
| Test | Iron deficiency | Thalassaemia trait (β) | Anaemia of chronic disease |
|---|---|---|---|
| MCV | Low | Very low for the degree of anaemia | Normal or slightly low |
| RDW | High | Normal | Normal |
| Ferritin | Low (below 12–15 µg/L) | Normal | Normal or high |
| Red-cell count and Mentzer (MCV/RBC) | Low; above 13 | High; below 13 | — |
| Deciding test | Response to iron: a haemoglobin rise of at least 1 g/dL within 4 weeks | HbA2 above 3.5% on electrophoresis | Inflammatory markers and the underlying disease |
Free exam questions
בן 3 שנים נבדק עקב חולשה והרגשה כללית לא טובה. המימצאים בספירת הדם נראים בטבלה. הטווח התקין תוצאה יחידות הבדיקה בסרום Hb g/dL 8.8 10.5-14 MCV fL 63 70-85 16.5 12-15 % RDW ml3 3.8 4-5.2 / RBC 109 ה .ותחל טיפול התואם למחלתו הסבירה מה מהבאים יהיה הסימן הראשון לתגובה לטיפול זה ? (the question as examined, in Hebrew)
- א. עליה ברמת פריטין
- ב. ירידה בדופק לטווח נורמה
- ג. עליה ברמת רטיקולוציטים
- ד. שיפור בהרגשה הכללית
A 9-year-old girl visits the doctor due to pallor, tiredness and glossitis. In anamnesis, she is on a vegetarian diet with limited food types. Blood tests: Hgb 9 mg/dL (normal over 11), MCV 115 fL (normal 80-90) Which nutritional component is most likely to be deficient in her diet?
- A. Folic acid
- B. Iron
- C. Vitamin B12
- D. Vitamin E
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Sources
- AAP Clinical Report: Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age), 2010 — Screening, prevention and treatment
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Iron-Deficiency Anemia
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.