Young patients with iron-deficiency anemia (IDA) showed variation in measures of health-related quality of life (HRQOL) over the course of treatment in a recent study. Additionally, fatigue appeared to improve over time with changes in hemoglobin levels. Study findings were presented in a poster at the 2023 ASPHO Annual Meeting by Luisanna M. Sánchez, MD, of Baylor College of Medicine and Texas Children’s Cancer and Hematology Center in Houston, Texas, and colleagues.

IDA is linked to poor neurocognitive and other outcomes in young patients, but little information has been available on how IDA affects HRQOL in these patients. Dr Sánchez and colleagues set out to measure outcomes including HRQOL, fatigue, and pica in pediatric patients who have IDA through the use of patient-reported outcome (PRO) tools and with reference to hematologic response.

The study included 3 age-based cohorts of patients with IDA. Cohort 1 included infants from 12 to under 24 months of age, while Cohort 2 included young children with an age from 24 to below 48 months of age, and Cohort 3 included adolescent females who were 13 to under 18 years of age.

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The Pediatric Quality of Life Inventory (PedsQL) was given to patients in all age cohorts. The PedsQL and other surveys were given to patients and parent proxies at visits across time points from baseline to 1 month, 3 months, and 6 months. 

A total of 102 patients enrolled in the study, with 66 of them participating in at least 1 follow-up visit and being included in analyses. This included 24 infants, 17 toddlers, and 25 teens. At baseline, there was evidence of pica in 29.2% of the infants, 64.7% of the toddlers, and 40% of the teens. In these age groups, mean hemoglobin levels at baseline were 8.5 g/dL, 7.5 g/dL, and 8.8 g/dL, respectively.

Hemoglobin levels increased over time for each of the patient cohorts (P <.001). Across time points, PedsQL scores varied, but statistically significant patterns were not observed for these scores.

However, for infants, a significant, positive correlation was observed between the PedsQL score and hemoglobin change across time points (r, 0.29; P =.04), with higher PedsQL scores suggesting better HRQOL.

In adolescents evaluated using a parental fatigue assessment, there was also a significant, positive correlation between the Multidimensional Fatigue score and hemoglobin levels (r=0.357; P =.033). Higher scores with this fatigue scoring system also suggest lower fatigue or better fatigue-related outcomes.

Children in Cohort 2 reportedly showed clinical improvements in PROs such as Physical and Social Functioning, but these changes did not appear correlated with hemoglobin response. In adolescent females, improvements were seen in scores on the PedsQL and for Multidimensional Fatigue that appeared associated with anemia resolution during the period from baseline to 3 months.

Dr Sánchez and colleagues concluded that the established PRO tools showed variation with IDA over the course of treatment. They also considered Multidimensional Fatigue scores to be positively linked to changes in hemoglobin status.


Sánchez L, Kim TO, Cohen CT, Grimes AB, Kirk SE, Powers JM. Health-related quality of life, fatigue, and pica: data from the Iron Deficiency Cohort Study. ASPHO 2023; May 10-13, 2023. Abstract 314.