Pediatric reference ranges for zinc protoporphyrin

Miller, Maureen J.; Soldin, Steven J.

doi:10.1016/s0009-9120(02)00405-8

Cited by 29 publications

(9 citation statements)

References 19 publications

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“…We found similar median ZPP/H levels in non-anemic children to those reported previously (47.5 and 58 μmol/mol heme). 15 , 16 Although evaluated systematically in children and non-anemic pregnant women with iron deficiency, 5 , 17 ZPP/H levels have not been studied either in women or preschool children using rigorous criteria for nutritional IDA. Only one large Indian study of tribal adults and children (<18 years) previously used ZPP/H to detect IDA in a subset (n=100) of anemic individuals (mean Hb 8.4) with normal Hb phenotype.…”

Section: Discussionmentioning

confidence: 99%

Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children

Kanuri

Chichula²,

Sawhney³

et al. 2018

Haematologica

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The detection of iron deficiency anemia is challenged by the paucity of diagnostic tests demonstrating high sensitivity and specificity. Using two biomarkers, zinc-protoporphyrin/heme and hepcidin, we established the diagnostic cut-off values for iron deficiency anemia in preschool children and women. We randomly selected non-anemic individuals (n=190; women=90, children=100) and individuals with iron deficiency anemia (n=200; women=100, children=100) from a preexisting cohort of healthy preschool children and their mothers. The diagnostic performance of these biomarkers was estimated by analyzing receiver operating characteristic curves. Diagnostic cut-offs with a high predictive value for iron deficiency anemia were selected. Median zinc-protoporphyrin/heme and hepcidin values in non-anemic children were 49 μmol/mol heme and 42 ng/mL, respectively, and in non-anemic women these values were 66 μmol/mol heme and 17.7ng/mL, respectively. Children and women with iron deficiency anemia had higher zinc-protoporphyrin/heme ratios (children=151 μmol/mol heme and women=155 μmol/mol heme) and lower hepcidin levels (children=1.2ng/mL and women=0.6ng/mL). A zinc-protoporphyrin/heme ratio cut-off >90 μmole/mole heme in children and >107 μmole/mole heme in women was associated with a high diagnostic likelihood for iron deficiency anemia (children, likelihood ratio=20.2: women, likelihood ratio=10.8). Hepcidin cut-off values of ≤6.8ng/mL in children and ≤4.5ng/mL in women were associated with a high diagnostic likelihood for iron deficiency anemia (children, likelihood ratio=14.3: women, likelihood ratio=16.2). The reference ranges and cut-off values identified in this study provide clinicians with guidance for applying these tests to detect iron deficiency anemia. Erythrocyte zinc-protoporphyrin/heme ratio is a valid point-of-care biomarker to diagnose iron deficiency anemia.

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Section: Discussionmentioning

confidence: 99%

Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children

Kanuri

Chichula²,

Sawhney³

et al. 2018

Haematologica

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“…There was a significant correlation between higher ZPP/H ratio and lower age of the children; median ZPP concentration declined with increasing age [11]. Mean ZPP (EP) increased from 6 months of age and reached a peak value at 1.5 y, and then gradually fell to a steady value around 6 y of age.…”

Section: Discussionmentioning

confidence: 99%

“…Mean ZPP (EP) increased from 6 months of age and reached a peak value at 1.5 y, and then gradually fell to a steady value around 6 y of age. This result likely reflects immature heme synthesis and increased erythrocyte volume in younger aged children [7,11,22]. …”

Section: Discussionmentioning

confidence: 99%

“…A cut-off of > 40 µmol of ZPP/mol heme was recommended in an adult study using a hematofluorometer on washed erythrocytes [24], while a cut-off of > 80 µmol of ZPP/mol heme was proposed using unwashed erythrocytes to diagnose ID [8]. Soldin et al [11] suggested a cutoff of 55.2 µmol of ZPP/mol heme in 5-9 year-old boys and girls, and Stanton et al [18] suggested the lead-screening cutoff for Protofluor-Z as 70 µmol of ZPP/mol heme. In a study of low-income, preschool-aged children, Crowell et al [1] used a ZPP level of > 69 µmol/mol heme as an indicator of iron depletion.…”

Section: Methodsmentioning

confidence: 99%

“…When plasma iron concentration decreases and erythrocyte protoporphyrin (EPP) accumulates, increased ZPP and free erythrocyte protoporphyrin (FEP) concentration can be measured [7,11]. Although ZPP measurement obtained with a hematofluorometer reflects the fraction of blood protoporphyrin that exists as a zinc chelate, whereas EPP measurement reflects the total protoporphyrin, the results for EPP and ZPP tests should be very similar [10,12].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of zinc protoporphyrin/heme ratio for screening iron deficiency in preschool-aged children

2011

Nutr Res Pract

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Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed, and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.

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Reference Values

Simpkin¹,

Hinchliffe²

2006

Pediatric Hematology

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Pediatric reference ranges for zinc protoporphyrin

Cited by 29 publications

References 19 publications

Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children

Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children

Effectiveness of zinc protoporphyrin/heme ratio for screening iron deficiency in preschool-aged children

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