Efficiency of red cell distribution width in identification of children aged 1-3 years with iron deficiency anemia against traditional hematological markers

Abstract

BackgroundCurrent strategy to identify iron deficiency anemia relies on markers involving high costs. Reports have suggested red cell distribution width (RDW) as a potential screening test for identifying iron deficiency anemia (IDA) but studies in pediatric populations are lacking. Our study elucidates the discriminative ability of RDW for detecting IDA among young children.Methods2091 blood reports of children aged 1–3 years from an urban low socio-economic population of Delhi were analyzed to evaluate the sensitivity of RDW in discriminating IDA using receiver’s operating characteristic curve. Hemoglobin and RDW were estimated using coulter, zinc protoporphyrin with AVIV fluorometer and serum ferritin by enzyme linked immunosorbent assay.ResultsA total of 1026 samples were classified as iron deficient anemia using gold standard. As a marker of overall efficiency, area under the curve for RDW was 0.83 (95% CI, 0.81- 0.84; p < 0.001). Sensitivity of RDW at cut-off of 18% to detect iron deficiency anemia was 76.5% and specificity 73.1% yielding a positive predictive value of 73% and negative predictive value of 76%. At a cut-off of RDW 16.4%, the sensitivity was 94% and at a cut-off of 21%, the specificity was 95%. Combination of hemoglobin ≤10 g/dL and RDW >15%, yielded a sensitivity of 99% and specificity of 90%. These data suggest that simple coulter analysis estimating hemoglobin and RDW can be used for identification of children in need for iron therapy.ConclusionsIn India and similar settings, RDW >15% with hemoglobin ≤10.0 g/dL identifies iron deficient anemic children without need for iron status markers which could help reduce cost of management especially in poor settings.Trial registrationClinicaltrials.gov NCT00255385.

Observed full blood count and lymphocyte subset values in a cohort of clinically healthy South African children from a semi-informal settlement in Cape Town

“…Blood films were reviewed manually to visually confirm automated differential counts and exclude gross morphological abnormalities. A Mentzer index (MCV/RBC) [10][11][12] was calculated for each participant. Dual-platform absolute lymphocyte subset counts and percentages were prepared using the Becton Dickinson FACSLyse/wash method (BDIS, USA).…”

“…Although iron deficiency and other metabolic disorders, including vitamin B 12 and folate deficiencies, were not formally excluded in this cohort, haematological indices and the Mentzer index calculation were assessed. [10] Iron deficiency was suspected if a concurrent Hb <10 g/ dL, RDW >15% [11] and Mentzer index >13 [10,12] was found. As noted in another local adult reference interval study, [14] the findings suggested that 14.2% (54/381) of the children tested in this study had possible iron deficiency (Table 3).…”

Can soluble transferrin receptor be used in diagnosing iron deficiency anemia and assessing iron response in infants with moderate acute malnutrition?

“…Meanwhile, it can be lowered in patients with malnutrition due to hypoproteinemia. 10,25 In our study, despite being within normal limits, transferrin was significantly higher in the MA group than controls (p <0.001). MA group didn't have hypoproteinemia (total protein level: 6.6 ± 0.73 g/dL) and transferrin levels were able to identify IDA.…”

“…Fe, TIBC, ferritin and transferrin are acute phase reactants that can be elevated depending on the presence of co-existing infectious or inflammatory processes. [8][9][10][11][12] Increased number of studies investigated the utility of sTfR in differentiating anemia in children. [13][14][15][16] sTfR is a truncated extracellular form of the transmembrane transferrin receptor (a glycoprotein primarily expressed in cells requiring iron) produced by proteolysis.…”

¿Puede usarse el receptor soluble de transferrina para diagnosticar anemia ferropénica y evaluar la respuesta al hierro en lactantes con desnutrición aguda moderada?

“…El Fe, la CTFH, la ferritina y la transferrina son proteínas de la fase aguda que pueden estar elevadas en presencia de procesos infecciosos o inflamatorios concurrentes. [8][9][10][11][12] …”