Abstract: Introduction: anemia is a worldwide public health problem. There are few studies that explore the knowledge that primary care physicians have about the diagnostic process in children and adolescents with anemia. Objective: to determine the level of clinical aptitude that the first-contact physician has regarding the diagnostic process of the pediatric patient in whom anemia is suspected. Material and methods: cross-sectional study. A seven-question questionnaire (developed by Delphi consensus) was applied to evaluate theoretical and practical concepts about the diagnostic process when anemia is suspected. The questionnaire was distributed electronically to general practitioners, family doctors, and pediatricians in the metropolitan area of Monterrey, Nuevo León, Mexico. Results: 154 doctors were included, 68 were pediatricians (44.2%), 51 family doctors (33.1%) and 35 general practitioners (22.7%). Of the total, 53.9% (n = 83) worked in a public institution. The median of correct answers was 5 (IQR 4-6). The highest proportion of correct answers was in anemia etiology (62.3%), followed by laboratory studies (48.1%), and initial clinical approach (14.9%). Compared to the other two groups, pediatricians obtained a higher percentage of correct answers. Conclusions: first-contact physicians have deficiencies in their clinical aptitude for the approach to pediatric patients with suspected anemia.

Resumen: Introducción: la anemia es un problema de salud pública a nivel mundial. Existen pocos estudios que exploran el conocimiento que los médicos de primer contacto tienen sobre el proceso diagnóstico en niños y adolescentes con anemia. Objetivo: determinar el grado de la aptitud clínica que tiene el médico de primer contacto sobre el proceso diagnóstico del paciente pediátrico en quien se sospecha de anemia. Material y métodos: se realizó un estudio transversal y descriptivo, en el cual se aplicó un cuestionario, desarrollado por consenso Delphi, con siete preguntas para evaluar conceptos teóricos y prácticos sobre el proceso diagnóstico cuando se sospecha de anemia. El cuestionario se distribuyó por medio electrónico a médicos generales, familiares y pediatras del área metropolitana de Monterrey, Nuevo León, México. Resultados: se incluyeron 154 médicos, 68 eran pediatras (44.2%), 51 médicos familiares (33.1%) y 35 médicos generales (22.7%). El 53.9% (n = 83) laboraba en institución pública. La mediana de respuestas correctas fue de 5 (RIC 4-6). Sobre la etiología de la anemia hubo el mejor desempeño (62.3%), seguido de estudios de laboratorio (48.1%) y de abordaje inicial (14.9%). En comparación a los otros dos grupos, los pediatras obtuvieron mayor porcentaje de respuestas correctas. Conclusiones: existen deficiencias en la aptitud clínica de los médicos de primer contacto para el abordaje del paciente pediátrico con sospecha de anemia.

Objective: By applying receiver operating characteristic curve analysis, the objective of this study was to see whether hemoglobin levels reflect body iron stores in a group of pregnant women at term who, by using serum ferritin as the reference test, had a high pre-test prob- ability of having iron deficiency anemia. Likewise, we evaluated the ability of hemoglobin and maternal serum ferritin levels to predict iron deficiency anemia in newborns. Methods: Hemoglobin and serum ferritin were measured in 187 pregnant women at term belonging to a group with a high pre-test probability of iron deficiency anemia and their newborns. Women with Hb <11.0 g/dL and newborns with cord Hb <13.0 g/dL were classified as anemic. A serum ferritin <12.0 µg/L in women and a cord blood serum ferritin <35.0 µg/L were considered to reflect empty iron stores. Receiver operating characteristic curve analysis was applied to select the cut-off points that better reflected iron stores. Results: The Hb cut-off point selected by receiver operating characteristic curve analysis in women was <11.5 g/dL (sensitivity: 60.82, specificity: 53.33%, Youden Index: 0.450). Most of the newborns had normal Hb which precluded this analysis. Maternal Hb <11.0 g/dL was the cut-off point that best reflected iron deficiency anemia in newborns (sensitivity: 55.88%, specificity: 57.24%, Youden Index: 0.217). The best cut-off point of maternal serum ferritin to reflect empty iron stores in newborns was <6.0 µg/L (sensitivity: 76.47%, specificity: 31.58%, Youden Index: 0.200). Conclusion: Hemoglobin concentration performed poorly to detect iron deficiency anemia in women at term with high risk for iron deficiency and their newborns.