Hemoglobin Testing: An Important Addition for the Back-to-School Checklist

With classes ending for most students, summer is the perfect time for parents to take steps to ensure their children will be in peak health for the coming school year. And of course, a thorough checkup is paramount to this goal!
Most parents understand the basic elements of routine examinations, but many are less familiar with hemoglobin testing and the role it plays in childhood health. Educating families about the use of the test and the implications of abnormal hemoglobin levels in children could help avert unfavorable effects on a child’s health and performance in school.

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Hemoglobin Testing: An Important Addition for the Back-to-School Checklist

July 13, 2021

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With classes ending for most students, summer is the perfect time for parents to take steps to ensure their children will be in peak health for the coming school year. And of course, a thorough checkup is paramount to this goal!

 

Most parents understand the basic elements of routine examinations, but many are less familiar with hemoglobin testing and the role it plays in childhood health. Educating families about the use of the test and the implications of abnormal hemoglobin levels in children could help avert unfavorable effects on a child’s health and performance in school.1

How Testing Helps

Hemoglobin is a protein molecule found in the red blood cells that facilitates the transport of oxygen from the lungs to other cells and back. Because oxygen is crucial to life, abnormal levels of hemoglobin can place a burden on the body’s physiological systems.

A person with higher than normal levels of hemoglobin is said to have polycythemia. Fortunately, this condition is quite rare in children and adolescents. On the other hand, a variety of events can trigger lower than normal hemoglobin levels in children:

    • The body is not making red blood cells. This can be due to poor nutrition and/or low iron.2
    • The body is destroying too many red blood cells. This can occur as a result of illness, such as sickle cell anemia, thalassemia, etc.2
    • The body is losing red blood cells. Blood loss can relate to normal body functions, such as menstruation, but also to chronic/acute conditions and illnesses.2
high five between father and child

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In children, a prevalent cause of low hemoglobin levels is anemia. Worldwide, anemia affects up to one-half of children younger than five years.1 It is estimated that 20% of American children will experience anemia during their childhood.3 To detect anemia, physicians test hemoglobin levels and use age-based norms to evaluate whether the condition is present. They may also incorporate gender-based norms for children 12 years of age or older.1

 

There are different varieties of anemia and the causes of anemia can vary by age. Common contributing factors are:3

 

    • Poor diet (often resulting in iron deficiency)
    • Blood loss
    • Inflammation from chronic conditions
    • Illness or infection
    • Medications

 

Anemia can occur in conjunction with periods of rapid growth, making children susceptible. Risk is particularly heightened when nutritional intake does not keep up with the body’s needs as growth speeds up. For this reason the first two years of life and adolescence are times when a child may be particularly prone to anemia. According to the Centers for Disease Control (CDC), iron deficiency is the most common form of nutritional deficiency.4


Loss of iron from menstrual flow combined with growth may also put adolescent girls at higher risk. In fact, the CDC stipulates that women of childbearing age are particularly prone to iron deficient anemia. This risk only increases with heavy blood flow.4


Failure to identify a low hemoglobin level in a child can have many detrimental effects:3

    • Developmental delays
    • Behavioral disturbances
    • Reduced motor abilities
    • Lower cognitive function
    • Attention disorders
    • Lack of social integration

 

Many of these effects can persist if not identified and addressed.

child with a headache

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Symptoms of anemia associated with a low hemoglobin level are not always apparent. Some children may be asymptomatic,3 but parents should be on the lookout for pallor, mood changes, fatigue and weakness.2 In some cases the lining of eyelids and nail beds may be less pink and jaundice may occur. In more severe cases, a child might experience shortness of breath, heart palpitations, swelling in the hands or feet, headaches, dizziness and/or pica, a disorder in which a person eats dirt, clay, paper or other nonfood items. In general, these symptoms are not specific to anemia,3 which heightens the importance of testing.


When it comes to testing, the guidelines differ:3

    • The Centers for Disease Control and Prevention recommends periodic screening for anemia among high-risk infants and preschool children to prevent iron deficiency. The organization also calls for testing of women of childbearing age.4
    • The American Academy of Pediatricians (AAP) currently recommends that hemoglobin (or hematocrit) be checked initially between the ages of 9 to 12 months. Additional screening between the ages of 1 and 5 years is suggested for patients at risk.1
    • According to the U.S. Preventive Task Force, high-risk infants should be screened. That group notes that there is insufficient evidence to assess the benefits vs. harms of screening.1

It is worth noting that the AAP guidance for hemoglobin testing in children was first issued in the mid-to-late seventies,5 prior to the introduction of hemoglobin photometers, the first system enabling accurate hemoglobin testing in near-patient settings.6 With a convenient and cost-effective test available for use in the office, it is easier than ever to evaluate a young patient’s hemoglobin level and avoid missing a serious health event.

Hemoglobin Testing Made Easy

HemoCue’s point-of-care hematology tests provide rapid lab-quality patient hemoglobin levels. Designed with proven, reliable technology, these hematology systems enable easy access to lab-quality results with minimal training and maintenance. Tests are easy to use, require no controls and provide lab-quality results in less than one minute.

The test is performed using a finger stick sample, which minimizes discomfort for young patients. The immediate results provide an opportunity to discuss abnormal readings and next steps with families during the patient visit. The convenience of going from assessment to treatment in minutes promotes timely healthcare and puts patients’ minds at ease. Click here to learn more about the HemoCue Hb 801 System for hemoglobin testing.

Health in childhood can set the path for growth and development. Furthermore, it can have implications for health later in life. With new and convenient ways to test hemoglobin, periodic screening of children and adolescents for conditions associated with abnormal hemoglobin levels makes more sense than ever.

Footnotes:
1 Wang, Mary. “Iron Deficiency and Other Types of Anemia in Infants and Children.” Am Fam Physician, vol. 93, no. 4, 2016 Feb. 15, pp. 270-278.
2 “Anemia in Children and Teens: Parent FAQs.” Centers for Disease Control, 24 Jan. 2019, https://www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htm.
3 Janus, Jennifer, et al. “Evaluation of Anemia in Children.” Am Fam Physician, vol. 81, no. 12, 2010 Jun. 15, pp. 1462-1471.
4 “Recommendations to Prevent and Control Iron Deficiency in the United States.” MMWR, Centers for Disease Control. 3 Apr. 1998, reviewed 2 May 2001.
5 Kohli-Kumar, M. “Screening for Anemia in Children: AAP Recommendations ‒ A Critique.” Pediatrics, vol. 108, no. 3, Sep. 2001, DOI: 10.1542/peds.108.3e56.
6 “HemoCue.” Danaher corporate website, viewed 9 Jul. 2021, https://www.danaher.com/our-businesses/diagnostics/hemocue.

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