Iron deficiency--a diagnostic problem.

The hypochromic, microcytic anemias are the most frequently encountered anemias on a world-wide scale, with iron deficiency anemia ranking as the commonest. Severe iron deficiency anemia seldom poses a problem in diagnosis if all the classical features are present. However, subclinical mild iron deficient states often require several laboratory tests to determine the diagnosis with certainty. To begin, the initial suspicion of an underlying subclinical iron deficient state is dependent on the laboratory method used to determine the red blood cell parameters. Next, many common conditions in children can influence the results of classical iron studies. Finally, iron deficiency has to be distinguished from other hypochromic, microcytic anemias, in particular the heterozygous thalassemic states which are so prevalent here in South-East Asia. This paper outlines some of these problems encountered in pediatric clinical practice.