345 - Iron-Deficiency Anemia in Pediatric Epistaxis Patients in the Emergency Department

Poster Number: 345
Publication Number: 345.15

Background: Iron deficiency is the most common cause of anemia in children, but there is no data on iron deficiency screening in pediatric patients with epistaxis seen in the emergency department (ED) setting.

Objective: To determine whether children with epistaxis are evaluated and treated for iron deficiency when bloodwork is obtained in the ED.

Design/Methods: We identified patients under 21 years old who were evaluated in our ED for epistaxis with bloodwork between July 2012 and June 2023 using retrospective review. Patients with a history of anemia, anticoagulation medication use, recent otolaryngological surgery, prior or newly diagnosed bleeding disorders, and oncological conditions were excluded. Anemia and microcytosis were defined as hemoglobin and mean corpuscular volume below the 2.5th percentile according to age and sex, respectively. Iron deficiency was defined as serum ferritin level less than 30 µg/L. Demographic, nosebleed, and laboratory data were analyzed using descriptive statistics.

Results: Of 184 total patients who were evaluated with bloodwork, 94 (51.1%) were female. The median hemoglobin was 12.8 g/dL (IQR 11.7-14.1). Eighteen (9.8%) patients had anemia, 20 (10.9%) had microcytosis, and 5 (2.7%) had both anemia and microcytosis. Patients with anemia were younger compared to those without anemia, mean 9.2 vs. 11.9 years, p=0.04. Anemia and microcytosis were not statistically significantly associated with sex, race, ethnicity, insurance, or duration of nosebleed. Only 6 (3.3%) patients had a ferritin performed; 4 (66.7%) had anemia, 3 (50%) had microcytosis, and 3 (50%) were found to have iron deficiency. Of the 3 patients with iron deficiency, 2 (66.7%) were discharged with oral iron therapy. Overall, 1 (0.5%) patient with normocytic anemia without iron deficiency received a blood transfusion, and no patients received intravenous iron therapy.

Conclusion(s): Children presenting to the ED with epistaxis are not often screened for iron deficiency despite the presence of anemia and microcytosis on bloodwork. In addition to diagnosing anemia, quality initiatives to improve the management of iron deficiency in pediatric epistaxis patients are necessary in the ED.