Table 2 Responses of participants to case 1
Case #1 A previously healthy 18-month-old male is referred to your clinic for evaluation of anemia. He was exclusively breastfed for 8 months, and since then has been receiving 1–1 ½ liter whole cow milk daily and limited iron-rich foods. The physical examination is normal except for pallor. His hemoglobin is 8.1 g/dL, RBC count 4 million/mm3, RDW 20%, and MCV 58 fL. No other laboratory tests were previously performed by the PCP. | ||
|---|---|---|
Respondent answers | % | |
In addition to a CBC, which of the following tests would you routinely obtain when first seeing such a patient in your office (Select all that apply)? | ||
1 | No other tests necessary | 15.6 |
2 | Reticulocyte count | 28.6 |
3 | Serum Ferritin | 70.7 |
4 | C-reactive Protein (CRP) | 4.8 |
5 | Serum Transferrin Saturation | 15.0 |
6 | Serum Iron | 38.8 |
7 | Hemoglobin Electrophoresis | 15.6 |
8 | Serum transferrin receptor | 6.1 |
9 | Reticulocyte hemoglobin content (CHr or Retic-He) | 3.4 |
10 | Blood lead level | 0 |
11 | Total iron binding capacity (TIBC) | 51.0 |
12 | Other (Please specify) | 2.0 |
Which oral iron preparation would you recommend (assuming insurance and access are not problematic)? | ||
1 | Ferrous sulphate (Fer-In-Sol®, Feromin®, Kdiron®) | 77.6 |
2 | Ferrousfumarate (Fumafer®,Ferretts®) | 6.8 |
3 | Ferrous gluconate (Ferrous gluconate®, Fergon®), | 3.4 |
4 | Iron (III)- hydroxide polymaltose (Ferose-F®, Ferose®) | 10.2 |
5 | Other (please specify) | 2.0 |
Which factors contribute to your recommended oral iron preparation (Select all that apply)? | ||
1 | Previous successful experience with it | 51.0 |
2 | Medical literature (published clinical studies involving that iron formulation) | 44.9 |
3 | Cost / Insurance | 16.3 |
4 | Taste / Tolerability | 29.3 |
5 | Practice / Recommendation of your partner(s) | 16.3 |
6 | Recommendation of the hematologist(s) with whom you trained | 16.3 |
7 | Other (please specify) | 5.4 |
What total daily elemental iron dose would you recommend (Select one)? | ||
1 | 2–3 mg/kg | 27.9 |
2 | 4–5 mg/kg | 32.0 |
3 | 6 mg/kg | 32.7 |
4 | other (please specify) | 6.8 |
5 | Missing | 0.6 |
If the patient’s hemoglobin was 6.1 g/d (rather than 8.1), what total daily elemental iron dose would you recommend (Select one)? | ||
1 | No change | 8.8 |
2 | 2–3 mg/kg | 5.4 |
3 | 4–5 mg/kg | 21.8 |
4 | 6 mg/kg | 47.6 |
5 | other (please specify) | 15.6 |
6 | Missing | 0.8 |
If the patient’s hemoglobin was10.1 g/dL (rather than 8.1), what total daily elemental iron dose would you recommend (Select one)? | ||
1 | No change | 19.0 |
2 | 2–3 mg/kg | 34.0 |
3 | 4–5 mg/kg | 24.5 |
4 | 6 mg/kg | 17.7 |
5 | other (please specify) | 4.1 |
6 | Missing | 0.7 |
How would you divide the total daily iron dose (Select one)? | ||
1 | Once daily (QDay) | 34.0 |
2 | Divided into 2 doses (BID) | 57.1 |
3 | Divided into 3 doses (TID) | 7.5 |
4 | Other (please specify) | 0.7 |
5 | Missing | 0.7 |
What is the hemoglobin value below which you would definitely recommend a blood transfusion (assuming the child looks “well compensated” with no co-morbidities) (Select one)? | ||
1 | There is no hemoglobin below which I would definitely recommend a blood transfusion | 21.8 |
2 | 3 g/dL | 7.5 |
3 | 4 g/dL | 2.0 |
4 | 5 g/dL | 14.3 |
5 | 6 g/dL | 40.1 |
6 | Other (please specify) | 11.6 |
7 | Missing | 2.7 |
Case #1 (continued) At a follow-up visit at 12 weeks, the patient’s hemoglobin is 12.2 g/dL, MCV 78 fL and ferritin 25 ng/mL, and his whole cow milk intake is limited. | ||
Would you recommend continued oral iron therapy (Select one)? | ||
1 | No | 31.3 |
2 | Yes, 1–2 additional month of iron therapy | 36.1 |
3 | Yes, 3 or more additional months of iron therapy | 25.9 |
4 | Other (please specify) | 4.1 |
5 | Missing | 2.6 |