Iron deficiency anaemia in infancy and early childhood Commentary

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Abstract
After release from a relatively hypoxic intrauterine environment, mean haemoglobin concentration falls by 30% to 110 g/1 by the eighth postnatal week, followed by a rise to 125 g/1 at 4 months. Mean haemoglobin then increases gradually to 135 g/1 in preadolescents.5 The lower 95% limit of the reference range from 6 months to 4 years for haemoglobin is 110 g/1, with corresponding values of 32% for packed cell volume, and 72 fl for mean corpuscular volume (MCV). Iron deficiency without anaemia implies that haemoglobin synthesis is impaired, but that haemoglobin concentration has not fallen sufficiently to meet the definition of anaemia. It is usually recognised on the basis of criteria other than haemoglobin concentration: serum ferritin (2.5 μg/g haemoglobin), MCV <72 fl, or a response to oral iron treatment (an increase in haemoglobin of at least 10 g/1 one month after starting on oral iron: 3 mg/kg, as ferrous sulphate, once daily before breakfast.6

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