QUESTION # 04
In a child with suspected iron-deficiency anemia, is a therapeutic trial with iron an acceptable diagnostic approach?
ANSWER:
Yes. If an infant or child is otherwise well, a therapeutic trial of 4 to 6 mg/kg/day of elemental iron can substitute for additional diagnostic testing (e.g., ferritin, transferrin saturation, free erythrocyte protoporphyrin), because dietary iron deficiency is the most likely cause of microcytic anemia. If the child is iron deficient, compliant with therapy, and there is not ongoing undetected blood loss, the hemoglobin should rise by >1 g/dL in about 2 weeks. If the hemoglobin does rise, therapy should be continued for an additional 2 months to replenish iron stores.
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