Overview Hemoglobin or hematocrit testing done to screen for

low serum iron levels as part of the assessment for nutritional risk

Performed in WIC clinic or by a medical provider in another setting

All WIC staff who do hemoglobin/hematocrit testing receive training locally or training provided by State

Overview Date & results of hematological tests recorded in

SDWIC-IT & logged according to requirements in WIC Laboratory Procedure Manual

Referral data from laboratory or health care provider may be used if obtained within specified time period for client’s status

Exceptions Medical Condition Prohibits Draw

Conditions such as hemophilia, fragile bones (osteogenesis imperfecta) or a serious skin disease in which the procedure (i.e. finger stick or venipuncture) of collecting the blood sample could cause harm to the client. The physician should be asked for referral data

Religious Objections

Exceptions Severe Risk to Staff for instance, a client who is kicking,

biting and placing staff at high risk of injury Client refuses to consent to blood work (this is not

routine) If the client has a risk code and every effort has been made to obtain blood work, clients cannot be denied benefits

If no other risk factors apply (extremely rare), the client is

not eligible to participate in WIC. Issue a Notice of Ineligibility

General Timeframes Infants

Initial screening 9-12 months of age New enrollments must have hemoglobin/hematocrit

prior to first birthday

Children (13-24 months of age) Hemoglobin/hematocrit done 6 months after first test if

given before 13 months; often this occurs at 18 month mid-cert assessment

If hemoglobin/hematocrit low, test redone at next 6 month visit; if normal, test redone in 12 months

General Timeframes Children (2-5 years)

For children with normal hemoglobin/hematocrit results, tests required every 12 months

For children with below normal hemoglobin/hematocrit results, tests required every 6 months until results improve to normal levels

Referral data may be used when obtained within the last 90 days

General Timeframes Women

Pregnant women need to have hematological test at the time of certification

Breastfeeding and non-lactating postpartum women need to have hematological test at the time of their certification

Other Practices Testing performed according to standard procedures

in WIC Laboratory Procedure Manual

Universal precautions must be used during all hematological testing

Retesting and follow-up testing may be done in certain situations

Clients with low results need to be educated on importance of nutrition interventions that improve iron levels and/or prescribed iron supplementation

SDDOH – Health & Medical Services Department of Health, Health & Medical Services (H&MS)

licensed nurses may perform or delegate to approved unlicensed staff accordingly to Administrative Rules 20:48:04.01 the following test Finger/toe/heel punctures for screening or monitoring of

hemoglobin

Department of Health Licensed Nutritionist may perform a finger/toe/heel puncture for screening or monitoring of hemoglobin as part of a WIC Certification.

WIC Lab Manual The purpose of this manual is to provide guidance to

clinic staff in WIC programs who routinely perform blood samples as a part of WIC services

WIC acknowledges the responsibility to provide optimal

care for its clients by maintaining the standards of the Department of Health, including standards used in blood screening for iron deficiency and in maintaining a meaningful Quality Assurance Program

WIC Lab Manual The goal of this manual is to provide staff with direction

on performing hematology screens for low serum iron Detailed procedures are provided to outline the

necessary steps in performing hemoglobin determination by HemoCue Hemoglobin Analyzer

WIC Lab Manual Laboratory Training is also provided periodically by the

South Dakota WIC Program Annually to ensure proficiency

Staff are referred to the WIC Policy and Procedure Manual related to Blood Borne Pathogens, OSHA and MIOSHA standards as an adjunct to the procedures stipulated here

Universal Precautions By highlighting existing CDC and HICPAC

recommendations, the WIC Guide to Infection Control

Provides basic infection prevention recommendations for outpatient (ambulatory care) settings

Reaffirms Standard Precautions as the foundation for

preventing transmission of infectious agents during patient care in all healthcare settings

Universal Precautions

Provides links to full guidelines and source documents, which readers can reference for more detailed background and recommendations

Retesting To insure test accuracy, clinics shall re-test in the

following situations

If the blood hemoglobin is <10.5 grams for any category. If the re-test confirms the first reading, the CPA should refer the participant to a physician for further testing and provide the results of testing to physician with a signed Release of Health Information from the client

If the blood hemoglobin is >15.0 grams for a pregnant woman in the 2nd or 3rd trimesters

If the re-test confirms the first reading, the CPA should refer the client to physician for further testing and provide the results of testing to the physician with a signed Release of Health Information from the client, due to potential pregnancy complications related to the poor blood volume expansion

Retesting

Retesting If the blood hemoglobin is >16.0 grams for any other

category. If the re-test confirms the first reading, the client should be counseled regarding adequate fluid intake

Clinics may perform one follow-up blood test (total of two tests per certification period) when deemed necessary for health monitoring by the CPA

Infants: A hematological test prior to 9-12 month recommended period may be appropriate when there are indications that the infant is at risk for low serum iron when Low birth weight or preterm infant On low iron formula for more than 2 months Has not been fed iron-fortified formula (10-12 mg Fe/liter) Has a known diagnosis of anemia Breastfed infant who does not consume a diet adequate in

iron after 6 months of age Has undergone surgery that resulted in excessive blood

loss Has been on cow’s milk prior to 12 months

Women and Children: Based on the assessments performed by the CPA, the following situations may indicate the need for an additional test for clients who have had a previous test result below or above cutoff levels Diet pattern indicates low intake of meat and Vitamin C Consuming more than 24 oz daily of cow’s milk Special health care needs as identified through the assessment

process Client appearance – pale skin and mucous membranes, low

energy levels Used medications that interfere with iron absorption and who

have chronic Infection, inflammatory disorders, restricted diets, or extensive blood loss from a wound, an accident or surgery

History indicates that iron supplement was prescribed, but client has failed to take daily iron supplement

Additional Test

Additional tests should be performed at least 60 days from the date of the previous low iron finding

Education Educate all clients with low iron readings regarding the

importance and necessity of dietary interventions that support improvement of iron levels and/or prescribed supplementation

Summary Hemoglobin /hematocrit testing done to screen for

low serum iron levels in WIC clients Results contribute to assessment for nutritional risk Performed in WIC clinic or by a medical provider in

another setting Specific timeframes for testing according to client

category, age and whether results are normal or below normal

Clients with below normal results are educated on nutrition interventions to improve iron status

Next Steps Refer to SD-WIC Policies 2.15 Hematological Risk

Determination & 5.01 B Nutrition Counseling for Anemia

Read following training materials & complete all observations & activities South Dakota WIC Laboratory Procedures Manual Guide to Infection Prevention in Outpatient Settings Hemoglobin Log Sheet HemoCue HB 201+ Operating Manual DOH-Health & Medical Services Standing Orders SP-

A-1 Scope of Practice Laboratory Testing pg. 52-53

Quiz 1. Hemoglobin testing should be performed on an infant

less than 6 months of age? True or False 2. Hemoglobin results may be used from a physician? True

or False 3. Referral Hemoglobin information may be older than 90

days? 4. If a hemoglobin result is low or high according to

normal limits a second test should be taken? True or False