Understanding sons blood test results - Hemoglobin

[godincenter]

Hi. So the pediatrician just called and said my 1 year old is anemic. His hemoglobin is 10.7 g/dL and it should be 12.5. He eats a lot of iron rich foods so I am confused by these results. Also, from researching, it looks like some charts don’t believe 10.7 g/dL is low? Although, sounds like pediatrician typically sees 12.5 so in that regard it is low. Does hemoglobin levels change from day to day? Could it be that he just didn’t eat enough iron that day or day prior? I looked up similar posts on Reddit and some ppl were concerned about developmental delays and lower iq being linked to iron deficiency? Just wanted to get other ppl’s (who are more educated than me on this topic) opinion on this! Thank you.

 

[jluponeage]

@godincenter Up to Date shows a reference range for his age of 11-13.5 g/dL, so he’s just below the target range. Iron-deficiency anemia is pretty common in 1 year olds, and isn’t dependent on what he ate yesterday. In general, people store a little extra iron when it’s plentiful and during short periods of lower iron intake can dip into their reserves, and you can be iron deficient without fully reaching anemia if your reserves are low. You measure the reserves by looking at blood ferritin level. So the bottom line is that if he’s anemic, you might be able to get his hemoglobin levels up by 0.3 g/dL to normal within a few days, but you’re not going to fix his ferritin levels and iron reserves without a larger change. It’s also worth asking your pediatrician if they want to do follow-up testing - things like B12 deficiency can also cause anemia, as well as genetic conditions and the like, so you want to know whether it’s actually iron deficiency or something else.

There are other nutrients and foods that can reduce your ability to absorb iron, like dairy, while vitamin C increases your iron absorption, so it could be in part due to what he’s eating with the iron-rich foods. Also, heme iron (from animal sources) is easier to absorb than non-heme iron (plant sources, supplements, etc).

As for things like behavior disorders and low IQ with iron deficiency, there’s some evidence for long-term sleep trouble and resulting behavioral issues, but the effect size seems to be measurable but small, and there are confounding factors like medical care in general, parental socioeconomic status, parental IQ, other environmental factors, etc. I wouldn’t be concerned about long-term effects so much as I would short-term - having been anemic, it certainly affected my mood, energy levels, mental acuity at the time because I was so fatigued, sleep, and anxiety levels. Since he can’t really tell you how he feels, you definitely want to address it with his pediatrician to make sure he’s feeling and functioning at his best.

 

[seatpost]

@godincenter Did your pediatrician recommend a next step to follow up this result? There are a lot of reasons hemoglobin can be low (and this is not very severe in terms of anemia, but should still be followed up according to your peds directions). If this was a finger prick test, the next step is likely a blood draw to get a better understanding of the characteristics of the red blood cells - are they too big, too small, all different sizes because they're dying too quickly, etc.

Iron deficiency is a really common reason for anemia in toddlers. The biggest culprit is kids drinking too much cows milk (more than 16-20oz a day).

There are also genetic forms of anemia - sickle cell disease, thalassemia, etc. You may or may not know this runs in your family. Different forms of anemia are more common amongst people of different ethnic backgrounds.

Lead toxicity can cause anemia (although the office near me does lead and hemoglobin testing together at 1 year old so maybe you already know this is normal?).

There are other reasons but those are the most common that I see. On any given day your hemoglobin might vary a little but probably not more than one whole number in each direction (I don't have a study to back that up but I look at a lot of daily labs in the hospital) - and typically not even by that much.

 

[godincenter]

@seatpost Hi! She recommended iron drops and to get tested again at 15 months. We got a lead blood test done but won’t know the results for 5 days. Both the tests were blood draws. Is 10.7 low that low?

 

[chamberlain94]

@godincenter Even if it isn't critically low medically speaking, why risk it decreasing further rather than getting it up to recommended levels now rather than later? At the current levels it should be fairly easy to fix, and your son won't risk feeling the effects of the levels dropping further.

 

[mrsgerragauch]

@chamberlain94 This. You don't want a small deficit to become a dangerous issue.

 

[mikesekurity]

@godincenter Pediatrician here. It's low, but not dangerously so. Just do the supplementation and re-check. Iron deficiency anemia is pretty common at this age, which is why we check.

 

[godincenter]

@seatpost By the way, he doesn’t drink any cows milk but eats a decent amount of cheese. Is that the same?

 

[jwd]

@godincenter It’s the milk and milk substitutes that inhibit the child from eating solids that’s an issue. But calcium does inhibit iron absorption while vitamin C promotes it. If your paediatrician is recommending an iron supplement your child should be taking it with a food that’s high in vitamin C.

 

[noenunez1]

@godincenter I will jump in from a lab prespective. Each instrument/manufacturer has their own reagents (these cause reactions and thus giving a reading for results). Based on the analyzer and the reagents they each have a very specific reference range which usually fall pretty much within any range you will see on google however sometimes there is a slight variance. So what may flag on one analyzer might not on another so while google says oh it’s not that low based on collected data it is actually low. Your doctor isn’t just making this assumption they are being told by the lab this value falls outside of our normal reference range. If your doctor is offering a solution until you have further testing it would be best to take that advice to start the reversal process versus waiting to find out if it gets worse. You can also ask to speak to a nutritionist who can guide you better on how to sneak iron in and what foods increase iron absorption.

 

[mrsgerragauch]

@godincenter Does he drink a lot of milk? Excessive calcium is known to inhibit iron absorption.

 

[despina]

@mrsgerragauch I’m here to blow everyone away since the objective is evidence! Vitamin C supplementation in iron deficiency anemia isn’t necessary. The initial research on this is rather antiquated and in recent years (and decades) there isn’t any great literature to show that vitamin C supplementation vastly improves iron absorption (via monitored serum levels). It’s essentially something we’ve previously learned and grown accustomed to recommending but in practice it increases cost of treatment, additional confusion, and anxiety and stress. The risks are low but but there isn’t sufficient evidence that you would feel the need to eat vitamin C rich foods and supplements with iron.

Main goal of treatment for anemia should be tolerance of iron supplement if choosen to take. Testing at 1 yr is futile in many countries as we know IDA is common between 1-2 yrs as maternal stores are reduced from 0-12 mos.

 

[mrsgerragauch]

@despina This is the first I've hearing of this. My doctor even reccomends taking iron tablets with foods rich in vitamin C. Can you share some links?

 

[despina]

@mrsgerragauch Yup. Plenty of docs practicing with anecdotes or antiquated advice.

Here’s a few but I mean these are cherry picked by me so there’s bias in my sources. If you want to tead further or learn more I suggest you also review literature on the advice on using vitamin C with iron to increase absorption to assess as well.

Li N, Zhao G, Wanling W, Zhang M, Liu W, Chen Q. The efficacy and safety of vitamin C for iron supplementation in adult patients with iron deficiency anemia: A randomized clinical trial. JAMA Netw Open. 2020 Nov 2;3(11):e2023644. doi:10.1001/jamanetworkopen.2020.23644

Cao G, Li K, Jin P, Yue X, Yang C, Hu X. Comparative bioavailability of ferrous succinate tablet formulations without correction for baseline circadian changes in iron concentration in healthy Chinese male subjects: a single-dose, randomized, 2-period crossover study. Clin Ther. 2011 Dec;33(12):2054-9. doi:10.1016/j.clinthera.2011.10.028

Simonson W. Should vitamin C routinely be given with oral iron supplements?. Geriatr Nurs. May-Jun 2019;40(3):327-328. doi:10.1016/j.gerinurse.2019.05.007

Stoffel N, Cercamondi C, Brittenham G, Zeder C, AJ Geurts-Moespotet, Swinkels DW, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol. 2017 Nov;4(11):e524-e533. doi:10.1016/S2352-3026(17)30182-5

Milman NT. A review of nutrients and compounds, which promote or inhibit intestinal iron absorption: Making a platform for dietary measures that can reduce iron uptake in patients with genetic haemochromatosis. J Nutr Metabol. 2020;2020:1-15. doi:10.1155/2020/7373498

Lopez A, Cacoub P, Macdougall I, Peyrin L. Iron deficiency anaemia. Lancet. 2016 Feb 27;387(10021):907-16. doi:10.1016/S0140-6736(15)60865-0

 

[godincenter]

@mrsgerragauch No milk. He breastfeeds. I do feed him some cheese probably daily though.

 

[mrsgerragauch]

@godincenter It's ok to have dairy, but you should just try to not have it with the same meals as iron.

Vitamin C, like tomato sauce or oranges help a lot when taken together with iron. So if he enjoys red pasta sauce that is an easy meal to help him absorb iron from meat or legumes.

We are a vegetarian household so I would make vegan chilli with legumes and tomatoes, or spaghetti with legumes in the sauce (think chilli mac) and those were a big hit.