A 5-year-old with pallor; Hb 8.5 g/dL and hematocrit 31% is evaluated by the NP. How will the child be managed?

A 5-year-old with pallor; Hb 8.5 g/dL and hematocrit 31% is evaluated by the NP. How will the child be managed?

• A. Reassure the parent that this represents mild anemia.
• B. Prescribe elemental iron and recheck labs in 1 month.
• C. Refer to a hematologist for further evaluation.
• D. Recommend a diet high in iron-rich foods.

Answer: (B)

The key idea is treating suspected iron deficiency anemia in a young child with a significant drop in hemoglobin. Starting oral elemental iron is the most appropriate first step. For a 5-year-old, typical dosing is about 3–6 mg of elemental iron per kg per day, given in divided doses, with the goal of raising the hemoglobin by roughly 1–2 g/dL over the next month. Rechecking labs in about 4 weeks confirms a response and ensures adherence and absorption; continuing iron for several months afterward replenishes iron stores. Reassurance would overlook the degree of anemia and pallor, which require treatment rather than dismissal. Referring to a hematologist isn’t needed initially unless there’s poor response, atypical features, or diagnostic uncertainty. Diet alone, while helpful as a supplement, won’t correct significant iron deficiency quickly enough in this scenario.

The key idea is treating suspected iron deficiency anemia in a young child with a significant drop in hemoglobin. Starting oral elemental iron is the most appropriate first step. For a 5-year-old, typical dosing is about 3–6 mg of elemental iron per kg per day, given in divided doses, with the goal of raising the hemoglobin by roughly 1–2 g/dL over the next month. Rechecking labs in about 4 weeks confirms a response and ensures adherence and absorption; continuing iron for several months afterward replenishes iron stores.

Reassurance would overlook the degree of anemia and pallor, which require treatment rather than dismissal. Referring to a hematologist isn’t needed initially unless there’s poor response, atypical features, or diagnostic uncertainty. Diet alone, while helpful as a supplement, won’t correct significant iron deficiency quickly enough in this scenario.