Iron status and its association with HbA1c levels in Dutch children with diabetes mellitus type 1
Marjolijn D. AkkermansE. C. A. M. HoudijkBoudewijn BakkerAgnes Clement-de BoersDaniëlle C M van der KaayMartine C. de VriesM. Claire WolteringDick MulJohannes B. van GoudoeverFrank Brus
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Absolute risk reduction
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Objectives: To assess the prevalence of anemia among children attending public preschools in Ilhabela, state of Sao Paulo, Brazil, and their response to a treatment regimen. Methods: Between 2007 and 2008, the weight, height, and hemoglobin levels of 667 children were measured in the school setting. Anemic children were prescribed a 12-week course of ferrous sulfate, and follow-up assessment visits were scheduled for halfway through this course and the end of treatment. Results: The prevalence of anemia was 25.6% (N = 170). The lowest hemoglobin level measured was 9.5 g/dL. Anemia was most prevalent (36%) in children between the ages of 60 and 65 months. Median hemoglobin levels rose to 11.8 g/dL from 10.5 g/dL after treatment; 76% of children recovered from anemia. Conclusion: Screening for anemia in the school setting and prompt therapy, including mid-treatment follow-up, proved to be an effective strategy for facing this major public health issue.
Regimen
Iron supplementation
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Background: Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. This study is conducted to assess the proportion of children, aged between 6 months to 5 years having anemia and risk factors of iron deficiency anemia among selected children with anemia. Methods: The present cross-sectional study was conducted in 500 children between the age of 6 months to 5 years, who were admitted (in patients) to the Department of Pediatrics of Dr. BR Ambedkar Medical College, Bangalore, were selected and screened for anemia by hemoglobin estimation. This study was carried out from November 2012 to April 2014. Among those children with hemoglobin <11 g/dl, were screened for iron deficiency anemia (Serum ferritin estimation is done). Among these 500 children, 100 children with a hemoglobin level of 11 gm/dl and serum ferritin <12 μg/L were taken up for detailed study. All the collected data was tabulated and statically analysed by using appropriate methods Results: 77.8% of screened children were found to have anemia. In studied children 38% had mild anemia, 54% had moderate anemia and 8% had severe anemia. Male outnumbered than female in the ratio of 1.17:1. More than 50% presented with acute gastroenteritis.79% of anemic children had malnutrition. 24% of anemic children were low birth weight. Dimorphic anemia was common in 6months to 5 years age group. Mean hemoglobin level was 9.26. Mean ferritin, mean serum iron, TIBC, transferrin saturation was 7.23 μg/l, 52.60μg/dl, 346.89mg/dl and 16.31% respectively Conclusions: The diet deficient in iron and other essential nutrients is the single most important cause of anemia in children of this age Diarrhea was the chief associated symptom in more than half the cases studied. Hence it is essential to make provision for safe drinking water and to improve sanitary facilities periodic deworming measure is advised, to reduce parasitic infestation which also contributes to the development of anemia.
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Foram estudados 10 doentes, portadores de anemia ancilostomótica e de grande parasitose. Foram determinados alguns parâmetros hematológicos como dosagem de hemoglobina, contagem de hemácias, hematócrito, volume corpuscular médio, hemoglobina corpuscular média, ferro sérico e siderofilina. Foram estudados o volume da perda de sangue intestinal, o ferro perdido nesta hemorragia e eliminado nas fezes, e o ferro reaborvido da hemorragia intestinal. Conclui-se que a reabsorção do ferro da hemoglobina por dia no tubo digestivo é de suma importância no retardamento da instalação da anemia ferropriva, causada pela parasitose ancilostomótica.
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Background and objective: HbA1c has been endorsed by the American Diabetes Association and World Health Organization to diagnose and monitor diabetes mellitus. Its value is directly proportional to the blood glucose level. However, besides the blood glucose level, other factors like iron deficiency anemia can affect HbA1c level. We conducted this study to reveal the impact of iron deficiency anemia on HbA1c level and to assess whether HbA1c result changes after the correction of iron deficiency anemia. Methods: Twenty five non-diabetic children who were confirmed to have iron deficiency anemia were enrolled. HbA1c, hemoglobin, serum iron, and ferritin were measured and compared at baseline and post-correction of iron deficiency anemia with a three-month age-appropriate dose of iron therapy. The baseline results were compared with 25 age- and sex-matched normal controls. Results: Children with iron deficiency anemia had significantly higher HbA1c level (6.144±0.6312, P <0.001) than the control group (5.032±0.5558, P <0.001). After three months of treatment of iron deficiency anemia, HbA1c significantly dropped (from 6.144±0.6312, P <0.001 to 5.604±0.51, P <0.001). Conclusion: This study concluded that HbA1c is inversely proportional to iron deficiency anemia in non-diabetic children, and treatment of iron deficiency anemia led to a drop in HbA1c level. Due to this false elevation of HbA1c by iron deficiency anemia, iron deficiency anemia should be considered and excluded before making the diagnosis or deciding on any therapeutic change in diabetic children. Keywords: Iron deficiency anemia; HbA1c; Non-diabetic children.
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Iron deficiency anemia is caused by decreased production of red blood cells (RBCs) and is characterized by a reduction in either the hematocrit (Ht) or the concentration of hemoglobin (Hb). It is detected by blood iron status measures that are below population reference standards and also below the "usual or normal" levels for an individual. In some medicine practices, usually only hemoglobin and hematocrit are routinely measured with a full blood count, without measuring the indicators of iron status. Biochemical measures that are collected on single occasion are difficult to interpret in individuals, and normal ranges of hemoglobin and hematocrit do not necessarily confirm an iron deficiency condition, because they decrease only when severe iron depletion is present and are often unreliable or misleading. Thus, iron-depleted individuals can quickly develop iron deficiency if not detected early.Information from hematological laboratory tests records on female patients at reproductive ages were collected and analysed.In this study, measurement of general test for anemia in some individuals revealed normal levels of RBCs count, Hb, Ht, mean corpuscular volume (MCV), mean cell hemoglobin concentration (MCHC), and cell morphology, whereas the levels of parameters of iron depletion and iron deficiency anemia such as serum iron and ferritin showed reduced values. The results indicate that individuals who are ordered cell blood count (CBC) measures alone without examining the indicators of iron status (Group C vs Group D) may not be correctly assessed with a definitive diagnosis and categorized as normal individuals. But in fact, they are susceptible to iron depletion and could develop iron deficiency anemia.In evaluation of iron deficiency status it is important that total CBC test be accompanied by the other tests of iron status to pinpoint true iron deficiency. Otherwise, many cases may be missed out and misdiagnosed as normal individuals.
Mean corpuscular hemoglobin
Red Cell
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Objective To examine the application value of reticulocyte hemoglobin content (CHr)for diagnosing iron deficiency in premenopausal women.Methods The levels of CHr,hemoglobin (Hb), mean cellular volume(MCV),red cell distribution width (RDW) were measured on the ADVIA 120 (Bayer Diagnostics) automated hematology analyzer.Transferrin saturation (TS) and ferritin (SF) were measured on chemistry analyzer.Results CHr in iron deficiency without anemia group were significantly lower than that in the healthy control group (P＜0.01)and significantly higher than that in iron deficiency anemia group(P＜0.01).CHr in anemia of chronic disease group were significantly higher than that in iron deficiency anemia group(P＜0.01).Receiver operator characteristic curve (ROC) analysis in diagnosis of iron dificiency without anemia demonstrated that the area under the curve for CHr,SF,RDW,MCV,Hb were 0.872,0.798,0.721,0.713,0.677,respectively (P＜0.01).So CHr has a better overall sensitivity than SF,Hb,MCV and RDW in the diagnosis of iron deficiency without anemia.ROC also showed that the area under the curve for Hb,RDW,CHr,SF and MCV was 1.000,0.969,0.958,0.953 and 0.926,respectively (P＜0.01) in iron deficiency anemia.Conclusion CHr is the early and sensitive predictor of iron deficiency in premenopausal women,especially for the diagnosis of iron deficiency without anemia.
Key words:
Iron; Deficiency diseases; Anemia,iron-deficiency; Erythrocyte indices
Reticulocyte
Transferrin saturation
Hematology analyzer
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In young children, iron deficiency (ID)-the most common cause of anemia-may adversely affect long-term neurodevelopment and behavior. We prospectively evaluated the prevalence of ID and iron deficiency anemia (IDA) in 256 healthy 18- to 36-month-old children in Northern Israel. Complete blood count and ferritin evaluation were performed, and risk factors were assessed. Hemoglobin (Hgb) was compared with first-year routine screening. Complete data were obtained from 208 children: 56.2% were boys; the mean age was 26.1±5.27 months. A prevalence of 5.8% IDA, 16.3% ID without anemia, 9.6% anemia with normal ferritin, and 68.3% normal Hgb and ferritin was found. In nonanemic infants at 1 year of age (n=156), ID/IDA was found in 19.9%, and 12.8% became anemic at study evaluation. Despite iron supplementation in the first year, and normal Hgb at first-year screening, ID and IDA were still prevalent, and might develop during the second year of life. Recognition of this child subset and consideration of iron supplementation are mandatory.
Iron supplementation
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Hypochromic anemia
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Objective
To find out the validity of assumption that anemia is used as an indicator of iron deficiency and children found to be anemic are put on supplemental iron.
Method
In this cross sectional study, children between 5-12 years of were tested for anemia and iron deficiency. Hemoglobin (Hb) of less than 11.5 gm/dl was defined as anemia. Serum iron 360 mcg/dl were used as an indicator of iron deficiency.
Results
Out of 319 school children, 87 (27%) were found to be anemic. Out of these, almost half (43 children) had no associated iron deficiency. Also, 130/319 (40.7%) children had depletion of iron stores, and out of these only 44 had anemia and 86 had iron deficiency without anemia. This makes both specificity and sensitivity of anemia low for iron deficiency. Positive predictive value of anemia for depleted iron stores was 50.6%. Sensitivity of anemia for depleted iron stores was 33.8%.
Conclusions
Since low hemoglobin is not a sensitive indicator of iron deficiency, and since iron deficiency is wide spread and causes multiple problems in children, we suggest that hemoglobin level should not be taken as the only indicator of iron status in children. (Rawal Med J 2009; 34: 61-64).
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