First of all, a hemoglobin of 10.9 is not severe anemia.  It is borderline,
but the exact interpretation depends on the standards of the lab.  Secondly,
labs also make errors.  Also, in the interpretation of any lab test
technique of taking the blood needs to be taken into account.  Poor
technique can completely destroy the value of a test result.

If the child is truly iron deficient, then the dose of iron is not too much.
However, is he truly iron deficient?  What else could cause a low hemoglobin
in a 15 month old?

1. lab error or misinterpretation as mentioned about.
2. thalassemia trait or sickle cell trait, or other hemoglobin abnormality,
*when iron should not be given under usual circumstances*.
3. high lead levels.

These are probably the most common, with #3 fairly uncommon.

I would suggest a repeat hemoglobin, maybe with a ferritin or iron and iron
binding capacity, but I would not get all excited about a hemoglobin of
10.9, especially if the child is eating some meat every day, (if he is truly
iron deficient).

Jack Newman, MD, FRCPC