Anemia is a major nutritional global problem of immense public health significance, affecting persons of all ages, sex and economic group. It is ranked as the commonest chronic malady of mankind affecting approximately 30% i.e. 1500 million people all over the world. It is a pathologic condition where hemoglobin or hematocrit level becomes abnormally low because of low essential nutrients regardless of the cause of these deficiencies. In developing countries like ours, besides deficiencies of food specific nutrients like iron, folic acid, B12 protein, vitamin C, vitamin E, trace elements etc, poor health facilities, poor socioeconomic status, faulty dietary patterns, the degree of urbanization, ethnic background, prevalence of hook worm and other worm infestations, repeated bacterial infections etc. also influence the incidence of anemia particularly in children. The nutritional anemia has major consequences not only on the morbidity and mortality in children but also affects growth and intellectual development of these children.

In India, anemia is the most common nutritional problem affecting more than 1/2 of the total population, particularly in children and pregnant women where the incidence is 50 to 97%. It has been suggested that prevalence of anemia in pre-school children, and pregnant women is sensitive index of the situation in the community. Iron deficiency anemia in children occurs most frequently between the age of 6 months to 3 years and 11 to 17 years.

Stages of iron deficiency :

Iron deficiency anemia is the end stage of a relatively long drawn process of deterioration in the iron status of the individual. It is only tip of iceberg of the iron deficiency state.

• Storage iron depletion (Prelatent iron deficiency) :
  
  Iron reserve is decreased or absent in this stage. At this stage, the only abnormalities are decreased iron stores and increased iron absorption from the gastrointestinal tract. It is characterized by reduced serum ferritin, reduced iron concentration in the marrow and liver tissue. Hemoglobin, serum iron, total iron binding capacity and transferrin saturation are within normal limits.
  
  
• Iron limited erythropoiesis (Latent iron deficiency) :
  
  As the iron stores gets exhausted, latent iron deficiency state develops. At this stage, in addition to already reduced iron stores (decreased serum ferritin), serum iron and transferrin saturation also are low with increased total iron binding capacity and increased free erythrocyte protoporphyrin. However, hemoglobin levels are still normal.
  
  
• Iron deficiency anemia :
  
  As the negative iron balance continues, now the production of erythroid cells in the marrow is impaired leading to reduction in hemoglobin concentration with development of progressive microcytic, hypochromic anemia. Thus, Hb, MCV, MCH & MCHC are reduced, in addition to already decreased serum iron, increased TIBC and decreased transferrin saturation. Transferrin saturation below 12-16% is diagnostic of iron deficiency state.