- Apply for WIC
- WIC Home
- Welcome to WIC!
- Shopping Help
- Local Agencies
- Health Care Providers
- Reports & Data
WIC 201 Low Hematocrit/Low Hemoglobin
Hemoglobin or hematocrit concentration below the 95 percent confidence interval (i.e., below the .025 percentile) for healthy, well-nourished individuals of the same age, sex, and stage of pregnancy.
Cut-off values are provided on the next page, based on the levels established by the Centers for Disease Control and Prevention (CDC).
Hemoglobin (Hb) and hematocrit (Hct) are the most commonly used tests to screen for iron deficiency anemia. Measurements of Hb and Hct reflect the amount of functional iron in the body. Changes in Hb concentration and Hct occur at the late stages of iron deficiency. While neither Hb nor Hct test are direct measures of iron status and do not distinguish among different types of anemia, these tests are useful indicators of iron deficiency anemia.
Iron deficiency is by far the most common cause of anemia in children and women of childbearing age. It may be caused by a diet low in iron, insufficient assimilation of iron from the diet, increased iron requirements due to growth or pregnancy, or blood loss. Anemia can impair energy metabolism, temperature regulation, immune function, and work performance. Anemia during pregnancy may increase the risk of prematurity, poor maternal weight gain, low birth weight, and infant mortality. In infants and children, even mild anemia may delay mental and motor development. The risk increases with the duration and severity of anemia, and early damages are unlikely to be reversed through later therapy.
1. Centers for Disease Control and Prevention. Criteria for anemia in children and childbearing-aged women. MMWR 1998:47: RR-3.
2. Centers for Disease Control and Prevention. Prenatal Nutrition Surveillance System User’s Manual. Atlanta: CDC, 1994.
3. Institute of Medicine. Iron deficiency anemia: recommended guidelines for the prevention, detection, and management among U.S. children and women of childbearing age. National Academy Press, Washington, D.C., 1993.
4. Institute of Medicine. Nutrition during pregnancy. National Academy Press, Washington, D.C., 1990.
5. Institute of Medicine. WIC nutrition risk criteria a scientific assessment. National Academy Press, Washington, D.C., 1996.
Basis for blood work assessment: For pregnant women being assessed for iron deficiency anemia, blood work must be evaluated using trimester values established by CDC. Thus, the blood test result for a pregnant woman would be assessed based on the trimester in which her blood work was taken.
Definition of Trimester: CDC defines a trimester as a term of three months in the prenatal gestation period with the specific trimesters defined as follows in weeks:
- First Trimester: 0-13 weeks
- Second Trimester: 14-26 weeks
- Third Trimester: 27-40 weeks
Further, CDC begins the calculation of weeks starting the first day of the last menstrual period. If that date is not available, CDC estimates that date from the estimated date of confinement (EDC). This definition is used in interpreting CDC’s Prenatal Nutrition Surveillance System data, comprised primarily of data on pregnant women participating in the WIC Program.
|Non-Smoking||Any smoking up to 20 cigarettes/day||Smoking 21 to 40 cigarettes/day||Smoking > 40 cigarettes/day|
|Status||Hgb & Hct||Hgb & Hct||Hgb & Hct||Hgb & Hct|
|PG 1st trimester||11.0 & 33.0||11.3 & 34.0||11.5 & 34.5||11.7 & 35.0|
|PG 2nd trimester||10.5 & 32.0||10.8 & 33.0||11.0 & 33.5||11.2 & 34.0|
|PG 3rd trimester||11.0 & 33.0||11.3 & 34.0||11.5 & 34.5||11.7 & 35.0|
|PP, BF: 12-14 years||11.8 & 35.7||12.1 & 36.7||12.3 & 37.2||12.5 & 37.7|
|PP, BF: 15-17 years||12.0 & 35.9||12.3 & 36.9||12.5 & 37.4||12.7 & 37.9|
|PP, BF: 18 years & older||12.0 & 35.7||12.3 & 36.7||12.5 & 37.2||12.7 & 37.7|
|Status||Age||Hct. %||Hgb., Grams|
- The objectives and intervention strategies are: To improve blood iron levels
- To achieve and maintain normal dietary intake patterns
- Assure regular care and follow-up with health care provider
The assessment should identify possible causes and/or contributing factors to low hemoglobin levels. Consider possible causes and/or contributing factors for low hemoglobin and tailor your assessment to these factors.
|Participant Category||Possible causes and/or contributing factors for low hemoglobin values||Areas for Assessment|
|Breastfeeding and Non-Breastfeeding Postpartum Women||
The Nutrition Counseling should incorporate the results of the assessment.
|Participant Category||Nutrition Counseling|
|Breastfeeding and Non-Breastfeeding Postpartum Women||
Provide referrals as necessary.
- All participants with a hemoglobin level that meets the high-risk criteria (<10) should be referred to the health care provider for therapy and follow-up.
- If the family has inadequate resources for purchasing food, refer to food assistance programs for which they may be eligible (e.g., SNAP, community food shelves, free/reduced school lunch program, soup kitchens, Fare Share)
- Offer other referrals as deemed necessary, such as, drug and alcohol abuse counseling, smoking cessation programs, mental health services or counseling for eating disorders.
Best practice for WIC documentation for this risk code:
- Document possible causes and/or contributing factors to low hemoglobin levels. Indicate plan for resolving low hemoglobin.
- Document any referrals made to the health care provider or other resource
Additional Resources include:
- Minnesota WIC Nutrition Modules – select the module Iron Deficiency Anemia in Women and Children
- AAP Clinical Report Diagnosis and Prevention of Iron Deficiency Anemia