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.[44] Delayed cord clamping has been shown to reduce the risk of anaemia in infants at high risk for IDA, compared with early clamping.[45]

The WHO also recommends routine iron supplementation in infants and young children living in areas where anaemia is highly prevalent.[46][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.[33] 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.[47] Term infants who are exclusively breastfed should receive iron supplementation from 4 months of age until appropriate iron-containing foods have been introduced.[33]

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.[48][49][50][51][52][53] [ ] [ ] [ ]

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.[6][54] 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.[55] [ ] If malaria is prevalent, then iron supplementation should be given concurrently with public health measures to prevent, diagnose, and treat malaria.[46][56][Evidence A] [ ]

The effects of iron on malaria are still unclear.[57]

Women of reproductive age

The WHO recommends oral iron supplementation to prevent anaemia in:[58][59][60]

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.[9] The American College of Obstetricians and Gynecologists recommends low-dose iron supplementation, starting in the first trimester, to reduce maternal anaemia prevalence at delivery.[61]

The US Preventive Services Task Force (USPSTF) and the British Society for Haematology found insufficient evidence to determine the balance of benefits and harms of routine iron supplementation in pregnant women.[62][63][64]

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.[53][65][66][67][68][69] 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.[70][71] [ ] [ ]

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).[72] 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.[73]

Use of this content is subject to our disclaimer

Iron deficiency anaemia

Primary prevention