Scientists reporting in this week's New England Journal of Medicine say that iron deficiency is not the chief cause of severe anemia, a life-threatening anemia in children, and that the condition is often mistaken for other diseases, resulting in unnecessary suffering and death. VOA's Jessica Berman has more.

Severe, life-threatening anemia, in which oxygen-carrying red blood cells fall to dangerously low levels, often accompanies a number of serious illnesses.

Experts say that in many cases of severe anemia, blood transfusions are needed. When blood is not available or when there are less serious cases, doctors commonly treat patients with iron supplementation.

But an international team of researchers studying children in Malawi found that iron supplementation may not be the appropriate treatment.

"I think the main surprising finding from our study is that iron deficiency is not associated with severe anemia. So, I think giving iron really might be something to reconsider," said Job Colis, a pediatrician at the University of Amsterdam in the Netherlands.

Colis and colleagues studied 381 severely anemic preschool children in both urban and rural settings in Malawi to try to identify the causes of their condition.

Researchers found that iron deficiency was in fact only responsible for a small number of cases of severe anemia, while the main causes were low-level blood infection known as bacteremia, infection with hookworm and vitamin B deficiencies. According to the study's authors, one in three children suffered from vitamin B12 deficiency.

Colis believes many anemic patients receive the wrong treatments because their symptoms mimic other diseases, such as malaria, and that they die as a result of the anemia.

Colis wants to see if it's possible to successfully treat severely anemic patients by giving them what he believes are appropriate treatments. "I think the next step forward would be to actually try these interventions to give children supplementation with vitamin B-12 or to treat bacteremia and to see if it actually prevents them from becoming severely anemic," he said.

The World Health Organization recommends treating severe anemia with iron supplementation, folic acid, which is a water soluable, B9 vitamin, and zinc. Except for iron, the study did not find that deficiencies in these supplements caused anemia in the childlren.

At best, Colis believes the WHO guidelines are lacking. "On the other hand, there are other interventions that you really need to question if it's worth the effort and actually might be dangerous, for example, give iron to these children," he said.

Without knowing what's causing the anemia, Colis says it's easy to give too much iron, which is toxic.

Meanwhile, investigators plan further research on the treatment of severe anemia in children hoping to provide evidence that will lead to revisions to the WHO guidelines.