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Anemia Resources
Reports and Data
WIC Reports and Data
Anemia in Children – Anemia data for children up to 5 years of age who are participating in the WIC Program.
Anemia in Women – Anemia data for pregnant and postpartum women participating in the WIC Program.
Infoview Reports
Infoview Reports Reference (PDF) - search for hemoglobin reports.
Infoview reports from FFY 2020-2021 Nutrition Education Plan
- Log in to InfoView.
- Click the Documents tab.
- Click on Folders in the lower left corner of the screen.
- Double-click Annual Reports under Public Folders.
- The Nutrition Education Plan folder is available. See Anemia reports for women and children.
Supplementation Recommendations
For Infants and Children:
Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Children (0-3 Years of Age) AAP. Key supplementation recommendations are found in the summary section:
- Summary, #1 - Term, healthy infants have sufficient iron for at least the first 4 months of life. Human milk contains very little iron. Exclusively breastfed infants are at increasing risk of ID after 4 completed months of age. Therefore, at 4 months of age, breastfed infants should be supplemented with 1 mg/kg per day of oral iron beginning at 4 months of age until appropriate iron-containing complementary foods (including iron-fortified cereals) are introduced in the diet. For partially breastfed infants, the proportion of human milk versus formula is uncertain; therefore, beginning at 4 months of age, partially breastfed infants (more than half of their daily feedings as human milk) who are not receiving iron-containing complementary foods should also receive 1 mg/kg per day of supplemental iron.
- Summary, #3 - For formula-fed infants, the iron needs for the first 12 months of life can be met by a standard infant formula (iron content: 10–12 mg/L) and the introduction of iron-containing complementary foods after 4 to 6 months of age, including iron-fortified cereals. Whole milk should not be used before 12 completed months of age.
- Summary, #5 - Preterm infants The preterm infant (LT 37 weeks' gestation) who is fed human milk should receive a supplement of elemental iron at 2 mg/kg per day starting by 1 month of age and extending through 12 months of age. This can be provided as medicinal iron or in iron-fortified complementary foods.
For Pregnant Women:
Risk code 427D Justification - Inappropriate Nutrition Practices for Women. See 427D Inadequate vitamin/mineral supplementation recognized as essential by national public health policy.
- The Recommended Dietary Allowance (RDA) for pregnant women is 27mg of iron per day. The Centers for Disease Control and Prevention recommends iron supplementation for all pregnant women to prevent iron deficiency; however, pregnant women should seek guidance from a qualified health care provider before taking dietary supplements.
Dietary Reference Intakes for Iron: Iron - Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc - NCBI Bookshelf (nih.gov) . RDA is 27 mg/day of iron during pregnancy.
Recommendations to Prevent and Control Iron Deficiency in the United States (cdc.gov). CDC recommends universal iron supplementation to meet iron requirements of pregnancy.
Training Opportunities
Prevent Iron Deficiency Anemia Module (HTML5) - Script (PDF)
As a staff, review state High-Risk guidance for Low Hemoglobin, found in the Implications for WIC Services, Risk Code 201. Complete the 201 High Risk Case Studies, which includes examples of enhanced nutrition assessment and care plans.
Examples of Local Agency Guidelines for Low Hemoglobin
EXAMPLE 1 - RAMSEY COUNTY WIC INCP GUIDELINES FOR LOW HEMOGLOBIN
Infants & Children:
INCP Guidelines - Criteria and Referrals Ramsey County WIC Program
| Low Hemoglobin (Infants & Children) | Future Appointment Guidance | Written Referrals/Forms |
|---|---|---|
| Hgb 9.0 to 10.0 | Nutrition Specialist for High Risk Visits (NS) 2 or 3 months (based on your assessment and syncing appointment) Tell client to contact MD within 1 week for follow up | Send Health Care Referral (HCR) |
| Hgb 8.1 to 8.9 | NS 1 month Tell client to contact MD within 24 hours to follow up | Send HCR |
| Hgb 5.1 to 8.0 | NS 1 month Ask: Do you live in an older home? Call client's MD from clinic, inform them of the situation and have family make appointment immediately. | Fax HCR to main office (Indicate lead test needed on HCR and refer to Healthy Homes Program) |
| Hgb 5 or below | NS 1 month Ask: Do you live in an older home? Do not let child leave clinic; tell family to take the child to Children's Hospital Emergency Room. | Fax HCR to main office (Indicate lead test needed on HCR and refer to Healthy Homes Program) |
Women: INCP Guidelines - Criteria and Referrals Ramsey County WIC Program
| Low Hemoglobin (Women) | Future Appointment Guidance | Written Referrals/Forms |
|---|---|---|
Pregnant = Hgb 9.0 to 10.0 Postpartum (PP) = 9.0 to 10.0 | Pregnant: Nutrition Specialist for High Risk Visits (NS) 2 or 3 months (based on your assessment and syncing appointment); Contact MD in 1 week PP: NS in 3 months | Send Health Care Referral (HCR) if mom is pregnant, and if PP mom is not followed by MD for low hgb |
| Hgb 7.1 to 8.9 | NS 1 month Tell client to contact MD within 24 hours to follow up | Send HCR (if ≤8 Fax HCR to main office) |
| Hgb 5.1 to 7.0 | NS 1 month Call the client’s MD from clinic, schedule ASAP | Fax HCR to main office |
| Hgb 5 or below | NS 1 month Call woman's MD from clinic; encourage woman to go to ER. | Fax HCR to main office |
EXAMPLE 2 - ANOKA COUNTY WIC GUIDELINES FOR LOW HEMOGLOBIN
ANOKA COUNTY WIC GUIDELINES FOR PARTICIPANTS WITH RISK FACTOR 201 AND HEMOGLOBIN IS ABOVE 10:
- 10.5 or higher
- issue up to 3 months of benefits (up to the date 3 months post the certification/MC).
- Verbal follow-up at the nutrition education visit
- If measurement information is referral data, WIC RD will contact family within 2 weeks to provide standard education if have not already provided.
- 10.0 to 10.4
- issue up to 3 months of benefits (up to the date 3 months post certification/MC)
- Offer a PHN referral for support
- Hemoglobin recheck at 3 months
- Hemoglobin can be checked in the WIC office, MD office, or on a home visit if already working with PHN
- If measurement information is referral data, WIC RD will contact family within 2 weeks to provide standard education if have not already provided.
Anoka County WIC Guidelines for Hemoglobin values LT 10
- Repeat the blood test assuring that proper blood collection techniques are used*
- Consult with WIC Lead Specialist or Supervisor after identifying low hemoglobin and before participant leaves clinic.
- Develop a follow-up plan with participant, update demographic information and document how to reach participant.
- Offer all participants with hemoglobin values LT 10 to PHN to assist participant with follow-up.
- Instruct participant to come for Follow-up in one month, only issue one month of food benefits to household, document in appointment alert.
- Notify Supervisor or WIC Clinic Coordinator with hemoglobin values LT 9 while participant is being seen for appointment. The Supervisor or WIC Clinic Coordinator can assist with follow-up.
INFANT OR CHILD
Hemoglobin value9 – 9.9
- Instruct participant to see primary care provider within one week.
- Send off fax referral form to primary care provider.
- At appointment, update primary care provider information, if this has changed obtain release of information. Verify current address and phone number(s) and notify participant that a WIC Dietitian will call participant in a week if referral form has not been completed by the primary care provider and returned to WIC.
- May assist participant in scheduling appointment from WIC clinic.
Hemoglobin value 7.1 – 8.9
- Instruct participant to see primary care provider within 24 hours.
- Assist participant in scheduling appointment from WIC clinic.
- Fax referral form to primary care provider.
- At appointment, update primary care provider information, if this has changed obtain release of information. Verify current address and phone number(s) and notify participant that a WIC Dietitian or supervisor will call participant following the scheduled appointment to verify follow-up with primary care provider.
Hemoglobin value 7.0 or less
- Call participant’s primary care provider and have participant talk with physician or nurse to schedule an appointment.
- Fax referral form to primary care provider.
- At appointment, update primary care provider information, if this has changed obtain release of information. Verify current address and phone number(s) and notify participant that a WIC Dietitian or supervisor will call participant following the scheduled appointment to verify follow-up with primary care provider.
Verify if participant has had a lead screening. Document information in Relevant WIC data area of Referral form and in HuBert notes.
* Refer to Section 5.3.2.2 Hemoglobin Using The HemoCue® Hemoglobin Photometer Procedure in the Minnesota Operations Manual
WOMEN
Hemoglobin value 9 – 9.9
- Instruct participant to see primary care provider within one week.
- Send of fax referral form to primary care provider.
- At appointment, update primary care provider information, if this has changed obtain release of information. Verify current address and phone number(s) and notify participant that a WIC Dietitian will call participant in a week if referral form has not been completed by the primary care provider and returned to WIC.
- May assist participant in scheduling appointment from WIC clinic.
Hemoglobin value 8.1 – 8.9
- Instruct participant to see primary care provider within 24 hours.
- Assist participant in scheduling appointment from WIC clinic.
- Fax referral form to primary care provider.
- At appointment, update primary care provider information, if this has changed obtain release of information. Verify current address and phone number(s) and notify participant that a WIC Dietitian or Supervisor will call participant following the scheduled appointment to verify follow-up with primary care provider.
Hemoglobin value 8.0 or less
- Call participant’s primary care provider and have participant talk with physician or nurse to schedule an appointment.
- Fax referral form to primary care provider.
- At appointment, update primary care provider information, if this has changed obtain release of information. Verify current address and phone number(s) and notify participant that a WIC Dietitian or supervisor will call participant following the scheduled appointment to verify follow-up with primary care provider.
ALL PARTICIPANTS
When hemoglobin value is LT 5.0: Consult with Supervisor or WIC Clinic Coordinator immediately. Call the participant's primary care provider. If after hours call Urgent Care, participant’s hospital Emergency Room, Mercy Hospital Emergency Room or Unity Hospital Emergency Room. Consult with care provider to see if an EMT/ambulance is needed to take participant to Emergency Room. Fax referral with signed consent to care provider, plan a follow-up call same day or next working day. If participant refuses to follow-up with primary care provider and leaves clinic, call Child Protection and consult with screener.
Participants who return for follow-up and hemoglobin values continue to be low, follow above instructions including calling the primary care provider with the participant at clinic to plan further education and follow-up related to the low hemoglobin values.