A child with beta-thalassemia minor and an Hgb of 8 g/dL should have which test before considering iron therapy?

• A. Evaluate serum ferritin
• B. Order Hgb electrophoresis
• C. Prescribe supplemental iron
• D. Refer for RBC transfusions

Answer: (A)

The key idea is to distinguish iron deficiency from thalassemia trait before starting iron therapy. In microcytic anemias like beta-thalassemia trait, giving iron without confirming iron status can lead to unnecessary treatment and iron overload. Serum ferritin directly reflects the body's iron stores, so it’s the best initial test to decide whether iron therapy is appropriate. If ferritin is low, iron supplementation can be beneficial; if ferritin is normal or high, iron therapy won’t help and could cause harm. While electrophoresis can confirm beta-thalassemia, it doesn’t tell you about iron needs. Transfusion isn’t indicated for mild anemia in beta-thalassemia trait, and starting iron without checking ferritin isn’t advisable.