Ask The Doctor


Dr. Erin Guest is a pediatric oncologist at Children’s Mercy Kansas City and an Associate Professor of Pediatrics, University of Missouri-Kansas City. She is the Director of the Children’s Mercy Cancer Genomic Program and the Oncology Biorepository, aka Tumor Bank. Her clinical and research area of focus is in leukemia in infants less than one year old. She is the Study Chair of a National Cancer Institute sponsored, Children’s Oncology Group international clinical trial for infants with acute lymphoblastic leukemia. She is also the Principle Investigator for a comprehensive genomics study of leukemia in infants.

What does a low iron mean?

Low iron, or iron deficiency, refers to inadequate amounts of iron stored in the body. Iron is required to make hemoglobin, an important molecule that carries oxygen in the blood. Iron is also very important for brain development. Children with iron deficiency can have anemia, learning delays, and behavior problems, as well as other neurologic problems. Iron deficiency anemia is diagnosed when the hemoglobin is below the expected range for the child’s age and development.

What are the common causes of iron deficiency anemia in children?

Iron deficiency anemia is most often the result of inadequate iron intake. Most commonly, we diagnose iron deficiency anemia in toddler-aged children who have switched to cow’s milk and who do not obtain enough iron in their diets. Toddlers who switch from formula or breast milk to cow’s milk before one year of age, who drink excessive cow’s milk, or who refuse to eat iron-rich foods can develop iron deficiency anemia. Iron deficiency anemia can also be caused by inadequate absorption in the GI tract or blood loss. In teenage girls, heavy menstrual cycles are a common cause of iron deficiency anemia.

How is it diagnosed?

Symptoms of iron deficiency anemia include pale skin, tiredness, and slow cognitive function. Pica, or eating non-food products such as ice, dirt, or paper, can occur. A low serum ferritin level is diagnostic of iron deficiency, but a normal or high ferritin does not necessarily rule out iron deficiency. A serum iron level is not very helpful because it varies day-to-day, depending on the child’s diet.  Other tests, such as high free erythrocyte protoporphyrin, high total iron binding capacity, or low transferrin saturation, can indicate iron deficiency. When anemia develops as a result of iron deficiency, the hemoglobin is low, the red blood cells are small and pale, and the reticulocyte count is low. The reticulocyte count measures the production of new red blood cells. The platelet count is often elevated. The workup should include a careful history, with special attention paid to the patient’s diet, to help identify the cause of iron deficiency.

For more information on Iron Deficiency Anemia, Dr. Erin Guest and the Children’s Mercy Hospital, go online at or call 816.234.3000.

You can contact the Pediatric Oncology Team at 816.234.3460.


Leave a reply