You raise a very interesting question, especially in light of a recent review/critique of the current AAP guidelines for anemia screening (Pediatrics, Sept, I think).  There is a growing concern that anemia (and maybe microcytosis) are late clinical manifestations of iron deficiency (and it's potential cognitive morbidity) WITHOUT anemia.

The review is balanced and is a great example of the evolution of good clinical practice based on evidence.

I would be in favor of forwarding (faxing or entering intoED visit documentation form) all microcytosis to the child's caregiver and allowing them to follow up.  It may allow them to make a difference before frank anemia.

Michael Forbes, MD
Pediatric CCM
Allegheny General Hospital
Department of Pediatrics
West Penn Allegheny Health System
Pittsburgh, PA USA

>>> "Higgins, Malcolm (PAED_EMERG)" <[log in to unmask]> 09/28/01 07:21 AM >>>
        I am interested to know how other PED's follow up microcytosis (ie
possible iron deficiency) incidentally found on a blood count done during
the emergency department visit. Our pracice has been to ring the parents and
arrange for them to come back for iron studies +/- Hb electrophoresis then
recontact them again with the results. With increased numbers of CBPs done
for febrile child evaluation the workload generated is becoming quite large.
We are planning to send out a letter to the parent and family doc containing
the relevant info. Does anyone else do anything similar or have any other
stategies for dealing with this time consuming problem?


> Dr Malcolm Higgins BM BS FRACP
> Staff Specialist
> Paediatric Emergency Department
> Women's and Children's Hospital
> 72 King William Roa
> North Adelaide
> South Australia 5006
> (08) 8204 7000 Phone
> (08) 8204 6142 Fax
> [log in to unmask]

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