Providing Evidence-Based Care for Pediatric Iron Disorders

While iron disorders are very common in pediatrics, specialty clinics dedicated to treating them aren’t. As one of the only pediatric iron disorders programs in the country, Texas Children’s Hospital specializes in iron-related blood disorders and their long-term impacts on health and quality of life.  

When to screen for deficiencies 

“When young children present to me for iron deficiency, the most common culprit is drinking cow milk as their primary source of nutrition,” said Jacquelyn Powers, MD, MS, director of the Iron Disorders and Nutritional Anemias Program at Texas Children’s, which sees more than 250 patients annually. “I’ll often see children drinking 4-6 bottles a day, sometimes more. Not only is cow milk low in iron, but the iron is also not well absorbed.” 

In other cases, the problem stems from iron being lost from the body, which may occur if an adolescent girl has heavy periods or from poor absorption into the body, such as from a gastrointestinal (GI) condition like inflammatory bowel disease. Therefore, ordering CBC and ferritin testing in these populations is recommended. 

“When patients present with these risk factors, it’s better to be more aggressive with screening rather than wait for symptoms,” Dr. Powers said. 

The program is also well suited to consult on patients who have iron disorders due to chronic medical conditions. With Texas Children’s nationally ranked Heart Center and gastrointestinal (GI) program, the Iron Disorders and Nutritional Anemias Program has easy access to partner with other Texas Children’s subspecialists for patients who have underlying heart or GI conditions. For example, patients with heart failure are routinely screened and treated for iron disorders before heart surgery, which helps minimize the use of blood products during surgery and the related potential complications. The team additionally follows many infants and children with intestinal failure who require intravenous iron therapy to support their nutrition and growth. In addition to those in cardiology and GI, Dr. Powers and her team often collaborate with partners in the NICU, as well as neurology, as iron disorders may impact other conditions. 

Referrals for specialty care 

When initial iron therapy fails to achieve the intended results, pediatricians often choose to refer to programs like Texas Children’s for these particularly complex or severe cases.  

“One of the unique services we can offer that’s typically not available is IV iron therapy in our infusion center, which allows us to achieve very good outcomes in shorter periods of time,” Dr. Powers said. “In the past, IV therapy was reserved for the most severe cases due to high risk of adverse events, but new drugs are available that can be used safely and effectively in children.”  

As a program that specializes in iron disorders and nutritional anemias, the Texas Children’s team has the ability to stay abreast of the latest evidence available. 

“We use the newest products available, with dosing and frequency based on recent literature, which enables us to be on the cutting edge of care,” Dr. Powers said. “In 2023, we expect to see an updated clinical report from the American Academy of Pediatrics on the screening, diagnosis and treatment of iron disorders.” 

Upcoming research to be published 

As both clinicians and researchers, Dr. Powers and her team contribute to the understanding of iron disorders and their treatment. Currently, the team is analyzing patient reported quality of life outcomes before and after treatment. 

“Iron deficiency anemia can cause symptoms such as fatigue and poor concentration, among others, but there hasn’t been a way to quantify their improvement,” Dr. Powers said. “In this study, we surveyed patients and their caregivers before treatment, as well as 1 month and 3 months following to see how their bloodwork compares with their self-reported outcomes.” 

Through this work, the team hopes to be able to inform patients and their families about how they might expect to feel and when, based on the results of previous patients. Dr. Powers and her team have been analyzing the results, which they plan to present at a national meeting later this year prior to publication by end of 2023. 

To refer a patient or for a second opinion, use our online referral system or call 832-TCH-CARE (832-824-2273).