Iron deficiency anaemia

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Infants and children

The World Health Organization (WHO) recommends delayed umbilical cord clamping to improve iron status and health outcomes in infants.[43] Delayed cord clamping has been shown to reduce the risk of anaemia in infants at high risk for IDA, compared with early clamping.[44]

The WHO also recommends routine iron supplementation in infants and young children living in areas where anaemia is highly prevalent.[45][Evidence B]

The American Academy of Pediatrics recommends iron supplementation between 1 and 12 completed months of age for infants who are born <37 weeks gestation and are breastfed.[32] Long-term use of enteral iron supplementation (≥8 weeks) in premature and low birthweight infants was associated with reduced risk of iron deficiency and anaemia in one review.[46] Term infants who are exclusively breastfed should receive iron supplementation from 4 months of age until appropriate iron-containing foods have been introduced.[32]

Systematic reviews report that use of iron-fortified foods (including micronutrient fortification) and iron supplementation in infants and primary school children (including those in low-income or middle-income countries) can improve haematological outcomes and reduce the risk of iron deficiency and anaemia.[47][48][49][50][51][52] [ ] [ ] [ ]

Malaria-endemic regions

There are reports that routine iron supplementation in preschool children in malaria-endemic areas may increase the risk of malaria and death.[5][53] However, one Cochrane review reported that iron supplementation, with appropriate malaria prevention or management services, does not increase the clinical risk of malaria in endemic regions.[54] [ ] If malaria is prevalent, then iron supplementation should be given concurrently with public health measures to prevent, diagnose, and treat malaria.[45][55][Evidence A] [ ]

The effects of iron on malaria are still unclear.[56]

Women of reproductive age

The WHO recommends oral iron supplementation to prevent anaemia in:[57][58][59]

Pregnant women living in areas where anaemia in pregnancy is highly prevalent
Menstruating women and girls living in areas where anaemia is highly prevalent[Evidence B]
Postpartum women living in areas where gestational anaemia is a public health concern (iron supplementation should be given with or without folic acid for 6 to 12 weeks following delivery).

The US Centers for Disease Control and Prevention recommends universal iron supplementation during pregnancy to meet increased iron demands.[8] However, the US Preventive Services Task Force (USPSTF) and the British Society for Haematology found insufficient evidence to recommend routine iron supplementation in pregnant women.[60][61]

Systematic reviews report that use of daily oral iron supplementation during menstruation or pregnancy can improve haematological outcomes and reduce the risk of iron deficiency and anaemia.[62][63][64][65][66][52] Intermittent iron supplementation during menstruation or pregnancy has similar efficacy to daily iron supplementation, although intermittent supplementation during pregnancy is more likely to result in mild anaemia near-term.[67][68] [ ] [ ]

One Cochrane review reported no difference in maternal outcomes (including maternal anaemia in the third trimester) with iron-containing multiple-micronutrient (MMN) supplementation during pregnancy compared with iron supplementation (with or without folic acid).[69] Use of MMN supplementation may be beneficial in low- to middle-income countries where micronutrient deficiencies are common in women of reproductive age.

lron supplementation has been shown to reduce the risk of anaemia among low-income, postnatal women.[70]

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Iron deficiency anaemia

Primary prevention