Serum Soluble Transferrin Receptor Is a Valuable Diagnostic Tool in Iron Deficiency of Breath-Holding Spells

Abstract

Iron-deficiency anemia may be a factor contributing to breath-holding spells. The serum transferrin receptor provides a useful measure of tissue iron deficiency. In this study of 50 breath-holders, while iron-deficiency anemia was detected in 28 (56%) of patients with routine tests, serum transferrin receptor levels were found increased in all patients. A positive correlation was detected between serum soluble transferrin receptor levels and frequency of attacks. It is suggested that the serum transferrin receptor level is useful as a single test for identification of iron deficiency in breath-holders. Moreover, if iron deficiency can be diagnosed earlier, then patients can be treated earlier.

Iron Supplementation for the Treatment of Breath-Holding Spells: A Systematic Review and Meta-Analysis

“…Five studies also reported responses among those patients with iron deficiency and without iron deficiency anemia. [9][10][11][12][13] In those studies, the meta risk reduction, 87% (95% confidence interval = 0.76-0.98), was approximately equivalent for both groups, suggesting that iron deficiency anemia is not a necessary Abbreviations: RCT, randomized clinical trial; IDA, iron deficiency with anemia; ID, iron deficiency without anemia; Both, iron deficiency without anemia and iron deficiency with anemia; NP, not provided. prerequisite for iron therapy in patients who are mildly iron deficient and have BHSs (Figure 2).…”

“…Of interest is the study by Handan where the investigators detected iron deficiency in subjects with BHSs through the use of the transferrin receptor diagnostic test when standard measures of iron store assessment was normal, and no anemia was present. 11 This suggests that subclinical forms of iron deficiency might be associated with BHSs and corrected by iron therapy. Perhaps the association between iron deficiency and BHSs is better attributed to iron deficiency, particularly in the brain where iron plays a key role in neuronal and glial energy metabolism, myelin synthesis, and neurotransmission.…”

Prevalence of breath holding spells among children in Gaziantep, Turkey

“…Nowadays "excessive vagal tone" or "vagal over activity" related to autonomic dysregulation is believed to be the primary biological basis of BHS [9,10]. An association between iron deficiency and BHS has been recognized [11,12]. Several studies have reported abatement of BHS with iron treatment, which may suggest a relationship between iron deficiency anemia and BHS.…”

Non‐Epileptic Paroxysmal Events of Childhood

“…More commonly iron studies are recommended, which may show presence of iron deficiency anemia or iron deficiency in up to 56% of patients [10].…”

“…Parental education about their benign nature, and reassurance are key in managing breathholding spells. Iron supplementation is often recommended as treatment, as iron supplementation has been shown to improve breath-holding spells [10]. Iron supplementation is most likely to be helpful in the presence of iron deficiency anemia, as suggested by several studies [11,12].…”