Infants and children can be prone to anemia for a variety of reasons throughout their first years of life and adolescence.

Anemia can be caused by diet, blood loss or other health conditions. Signs and symptoms may include pallor, jaundice, scleral icterus, exercise and/or feeding intolerance and general fatigue. Anemia can be detected during a complete blood count, and generally speaking, it can be easy to treat, especially if detected early.

Natalie F. Slone, D.O., pediatric hematologist/oncologist with Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine, provides guidance for pediatricians and other providers when it comes to referring anemia patients.

Iron deficiency anemia

“Many pediatricians are not comfortable treating iron deficiency anemia, which is totally fine,” Dr. Slone said.

If a pediatrician already has started treatment and monitoring for a patient with iron deficiency anemia, a patient should be referred for any of the following criteria:

• Microcytic anemia is not resolving with appropriate oral iron treatment.
• Patient has oral iron intolerance or medication noncompliance.
• Patient requires intravenous iron therapy.
• Hemoglobin levels are around 6 grams per deciliter (g/dL) in toddlers/children and around 7 to 8 g/dL in teenagers.

It’s important to note that patients with symptomatic iron deficiency anemia or hemoglobin values of less than 5g/dL should be sent to the emergency department.

Thalassemia traits

If the patient has suspected or confirmed thalassemia traits, refer so a hematologist can confirm their diagnosis and/or provide education, according to Dr. Slone.

Suspected hemolysis

If you suspect hemolysis, based on the patient’s labs, signs and symptoms, or if there’s a family history of hemolytic disease, the patient should be referred.

“We definitely like to see these patients and do our own testing, so if confirmed, we can monitor them closely,” Dr. Slone said. “Children who do have a hemolytic disease often need a lot of blood products in the beginning of life, but that certainly slows down as they get older.”