Implementation of a Standard Algorithm for Emergency Department Management of Iron Deficiency Anemia

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Pediatric Blood & Cancer

Abstract

Background: Iron deficiency anemia (IDA) is common in young children and may result in morbidity such as fatigue, poor growth, neurocognitive impairment, or stroke [1,2]. Complications may be reduced by prompt diagnosis and correction of anemia via decreased cow's milk intake, iron supplementation, and, in some cases, transfusion of red blood cells (RBCs). Previously published literature suggests that development of standard protocols for IDA management in the pediatric emergency department (ED) can help improve medical care decisions without negative impacts on key quality metrics such as length of stay (LOS) [3].

Objectives: We aimed to improve quality of care for IDA in our institution's pediatric ED by introducing a standardized algorithm (Figure 1) for management of suspected IDA with subsequent evaluation of key metrics such as initial diagnostic workup, ED disposition, LOS, and transfusion rates [3].

Design/Method: An IDA management algorithm mirroring published literature was provided to Pediatric Emergency Medicine and Pediatric Hematology/Oncology physicians in July 2024 [3]. ED encounters from February 2023 through August 2024 (baseline) and September 2024 through October 2025 (post-implementation) involving children aged 12-60 months with a visit diagnosis of anemia were reviewed. Charts were excluded from review for pre-existing hematologic disease or transfer of care from another hospital.

Results: Seventy-two ED encounters met criteria for IDA algorithm use. Median age at time of visit was 22 months with median hemoglobin of 7 mg/dL and MCV of 59 fL. After algorithm implementation, median adherence to recommended reticulocyte count testing increased from 50% to 62.5% and metabolic panel testing from 40% to 66.7%. Median adherence to transfusion guidelines increased from 81.7% to 100%. Hospitalization rates decreased from 41.9% to 20.7%. ED LOS was similar at 224 min before implementation and 215 min after implementation.

Conclusion: Implementation of a standardized algorithm for IDA management at our institution resulted in improved adherence to best practices for IDA management without increasing ED LOS. Forthcoming PDSA cycles will seek to further improve adherence through broadened publication of the algorithm, education for resident physicians, prompts and shortcuts in the electronic medical record, and expanding physician access to intravenous iron order sets.

Volume

73

Issue

Suppl 2

First Page

s206

Comments

American Society of Pediatric Hematology/Oncology(ASPHO) Conference, April 29-May 2, 2026, Minneapolis, MN

Helen DeVos Children’s Hospital

Last Page

s207

DOI

10.1002/1545-5017.70343

ISSN

1545-5009

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