Challenges in the diagnosis of iron deficiency in children exposed to high prevalence of infections
While WHO guidelines recommend iron supplements to only iron-deficient children in high infection pressure areas, these are rarely implemented. One of the reasons for this is the commonly held view that iron supplementation increases the susceptibility to some infectious diseases including malaria....
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| Veröffentlicht in: | PloS one 2012-11, Vol.7 (11), p.e50584 |
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| description | While WHO guidelines recommend iron supplements to only iron-deficient children in high infection pressure areas, these are rarely implemented. One of the reasons for this is the commonly held view that iron supplementation increases the susceptibility to some infectious diseases including malaria. Secondly, currently used markers to diagnose iron deficiency are also modified by infections. With the objective of improving iron deficiency diagnosis and thus, its management, we evaluated the performance of iron markers in children exposed to high infection pressure.
Iron markers were compared to bone marrow findings in 180 anaemic children attending a rural hospital in southern Mozambique. Eighty percent (144/180) of the children had iron deficiency by bone marrow examination, 88% (155/176) had an inflammatory process, 66% (119/180) had moderate anaemia, 25% (45/180) severe anaemia and 9% (16/180) very severe anaemia. Mean cell haemoglobin concentration had a sensitivity of 51% and specificity of 71% for detecting iron deficiency. Soluble transferrin receptor (sTfR) and soluble transferrin receptor/log ferritin (TfR-F) index (adjusted by C reactive protein) showed the highest areas under the ROC curve (AUC(ROC)) (0.75 and 0.76, respectively), and were the most sensitive markers in detecting iron deficiency (83% and 75%, respectively), but with moderate specificities (50% and 56%, respectively).
Iron deficiency by bone marrow examination was extremely frequent in these children exposed to high prevalence of infections. However, even the best markers of bone marrow iron deficiency did not identify around a quarter of iron-deficient children. Tough not directly extrapolated to the community, these findings urge for more reliable, affordable and easy to measure iron indicators to reduce the burden of iron deficiency anaemia in resource-poor settings where it is most prevalent. |
| doi_str_mv | 10.1371/journal.pone.0050584 |
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Iron markers were compared to bone marrow findings in 180 anaemic children attending a rural hospital in southern Mozambique. Eighty percent (144/180) of the children had iron deficiency by bone marrow examination, 88% (155/176) had an inflammatory process, 66% (119/180) had moderate anaemia, 25% (45/180) severe anaemia and 9% (16/180) very severe anaemia. Mean cell haemoglobin concentration had a sensitivity of 51% and specificity of 71% for detecting iron deficiency. Soluble transferrin receptor (sTfR) and soluble transferrin receptor/log ferritin (TfR-F) index (adjusted by C reactive protein) showed the highest areas under the ROC curve (AUC(ROC)) (0.75 and 0.76, respectively), and were the most sensitive markers in detecting iron deficiency (83% and 75%, respectively), but with moderate specificities (50% and 56%, respectively).
Iron deficiency by bone marrow examination was extremely frequent in these children exposed to high prevalence of infections. However, even the best markers of bone marrow iron deficiency did not identify around a quarter of iron-deficient children. Tough not directly extrapolated to the community, these findings urge for more reliable, affordable and easy to measure iron indicators to reduce the burden of iron deficiency anaemia in resource-poor settings where it is most prevalent.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0050584</identifier><identifier>PMID: 23209786</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Anemia ; Anemia, Iron-Deficiency - diagnosis ; Anemia, Iron-Deficiency - metabolism ; Area Under Curve ; Biomarkers - metabolism ; Blood ; Bone marrow ; Bone Marrow Examination ; C-reactive protein ; Case-Control Studies ; Child, Preschool ; Children ; Developing countries ; Diagnosis ; Diseases ; Epidemiology ; Exposure ; Female ; Ferritin ; Ferritins - metabolism ; Hemoglobin ; Hemoglobins ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Infections ; Infectious diseases ; Inflammation ; Iron ; Iron deficiency ; LDCs ; Malaria ; Male ; Markers ; Medical diagnosis ; Medical research ; Medicine ; Mozambique ; Nutrient deficiency ; Physiology ; Plasma ; Pressure ; Prevalence ; Public health ; Receptors, Transferrin - metabolism ; Statistical methods ; Streptococcus infections ; Supplementation ; Supplements ; Transferrin ; Transferrins ; Vector-borne diseases</subject><ispartof>PloS one, 2012-11, Vol.7 (11), p.e50584</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Aguilar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2012 Aguilar et al 2012 Aguilar et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-44faf338b5d80b990facb9600cff1d3e16959a8a6dd3acf0216cb3d3274931233</citedby><cites>FETCH-LOGICAL-c692t-44faf338b5d80b990facb9600cff1d3e16959a8a6dd3acf0216cb3d3274931233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507793/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507793/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23209786$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bruce, Amanda</contributor><creatorcontrib>Aguilar, Ruth</creatorcontrib><creatorcontrib>Moraleda, Cinta</creatorcontrib><creatorcontrib>Quintó, Llorenç</creatorcontrib><creatorcontrib>Renom, Montse</creatorcontrib><creatorcontrib>Mussacate, Lázaro</creatorcontrib><creatorcontrib>Macete, Eusebio</creatorcontrib><creatorcontrib>Aguilar, Josep L</creatorcontrib><creatorcontrib>Alonso, Pedro L</creatorcontrib><creatorcontrib>Menéndez, Clara</creatorcontrib><title>Challenges in the diagnosis of iron deficiency in children exposed to high prevalence of infections</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>While WHO guidelines recommend iron supplements to only iron-deficient children in high infection pressure areas, these are rarely implemented. One of the reasons for this is the commonly held view that iron supplementation increases the susceptibility to some infectious diseases including malaria. Secondly, currently used markers to diagnose iron deficiency are also modified by infections. With the objective of improving iron deficiency diagnosis and thus, its management, we evaluated the performance of iron markers in children exposed to high infection pressure.
Iron markers were compared to bone marrow findings in 180 anaemic children attending a rural hospital in southern Mozambique. Eighty percent (144/180) of the children had iron deficiency by bone marrow examination, 88% (155/176) had an inflammatory process, 66% (119/180) had moderate anaemia, 25% (45/180) severe anaemia and 9% (16/180) very severe anaemia. Mean cell haemoglobin concentration had a sensitivity of 51% and specificity of 71% for detecting iron deficiency. Soluble transferrin receptor (sTfR) and soluble transferrin receptor/log ferritin (TfR-F) index (adjusted by C reactive protein) showed the highest areas under the ROC curve (AUC(ROC)) (0.75 and 0.76, respectively), and were the most sensitive markers in detecting iron deficiency (83% and 75%, respectively), but with moderate specificities (50% and 56%, respectively).
Iron deficiency by bone marrow examination was extremely frequent in these children exposed to high prevalence of infections. However, even the best markers of bone marrow iron deficiency did not identify around a quarter of iron-deficient children. Tough not directly extrapolated to the community, these findings urge for more reliable, affordable and easy to measure iron indicators to reduce the burden of iron deficiency anaemia in resource-poor settings where it is most prevalent.</description><subject>Age</subject><subject>Anemia</subject><subject>Anemia, Iron-Deficiency - diagnosis</subject><subject>Anemia, Iron-Deficiency - metabolism</subject><subject>Area Under Curve</subject><subject>Biomarkers - metabolism</subject><subject>Blood</subject><subject>Bone marrow</subject><subject>Bone Marrow Examination</subject><subject>C-reactive protein</subject><subject>Case-Control Studies</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Developing countries</subject><subject>Diagnosis</subject><subject>Diseases</subject><subject>Epidemiology</subject><subject>Exposure</subject><subject>Female</subject><subject>Ferritin</subject><subject>Ferritins - metabolism</subject><subject>Hemoglobin</subject><subject>Hemoglobins</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Inflammation</subject><subject>Iron</subject><subject>Iron deficiency</subject><subject>LDCs</subject><subject>Malaria</subject><subject>Male</subject><subject>Markers</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Mozambique</subject><subject>Nutrient deficiency</subject><subject>Physiology</subject><subject>Plasma</subject><subject>Pressure</subject><subject>Prevalence</subject><subject>Public health</subject><subject>Receptors, Transferrin - 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One of the reasons for this is the commonly held view that iron supplementation increases the susceptibility to some infectious diseases including malaria. Secondly, currently used markers to diagnose iron deficiency are also modified by infections. With the objective of improving iron deficiency diagnosis and thus, its management, we evaluated the performance of iron markers in children exposed to high infection pressure.
Iron markers were compared to bone marrow findings in 180 anaemic children attending a rural hospital in southern Mozambique. Eighty percent (144/180) of the children had iron deficiency by bone marrow examination, 88% (155/176) had an inflammatory process, 66% (119/180) had moderate anaemia, 25% (45/180) severe anaemia and 9% (16/180) very severe anaemia. Mean cell haemoglobin concentration had a sensitivity of 51% and specificity of 71% for detecting iron deficiency. Soluble transferrin receptor (sTfR) and soluble transferrin receptor/log ferritin (TfR-F) index (adjusted by C reactive protein) showed the highest areas under the ROC curve (AUC(ROC)) (0.75 and 0.76, respectively), and were the most sensitive markers in detecting iron deficiency (83% and 75%, respectively), but with moderate specificities (50% and 56%, respectively).
Iron deficiency by bone marrow examination was extremely frequent in these children exposed to high prevalence of infections. However, even the best markers of bone marrow iron deficiency did not identify around a quarter of iron-deficient children. Tough not directly extrapolated to the community, these findings urge for more reliable, affordable and easy to measure iron indicators to reduce the burden of iron deficiency anaemia in resource-poor settings where it is most prevalent.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23209786</pmid><doi>10.1371/journal.pone.0050584</doi><tpages>e50584</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2012-11, Vol.7 (11), p.e50584 |
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| source | PubMed (Medline); PLoS; MEDLINE; Full-Text Journals in Chemistry (Open access); Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Age Anemia Anemia, Iron-Deficiency - diagnosis Anemia, Iron-Deficiency - metabolism Area Under Curve Biomarkers - metabolism Blood Bone marrow Bone Marrow Examination C-reactive protein Case-Control Studies Child, Preschool Children Developing countries Diagnosis Diseases Epidemiology Exposure Female Ferritin Ferritins - metabolism Hemoglobin Hemoglobins Hospitals Humans Infant Infant, Newborn Infections Infectious diseases Inflammation Iron Iron deficiency LDCs Malaria Male Markers Medical diagnosis Medical research Medicine Mozambique Nutrient deficiency Physiology Plasma Pressure Prevalence Public health Receptors, Transferrin - metabolism Statistical methods Streptococcus infections Supplementation Supplements Transferrin Transferrins Vector-borne diseases |
| title | Challenges in the diagnosis of iron deficiency in children exposed to high prevalence of infections |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T15%3A58%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Challenges%20in%20the%20diagnosis%20of%20iron%20deficiency%20in%20children%20exposed%20to%20high%20prevalence%20of%20infections&rft.jtitle=PloS%20one&rft.au=Aguilar,%20Ruth&rft.date=2012-11-27&rft.volume=7&rft.issue=11&rft.spage=e50584&rft.pages=e50584-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0050584&rft_dat=%3Cgale_plos_%3EA477013818%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1350901816&rft_id=info:pmid/23209786&rft_galeid=A477013818&rft_doaj_id=oai_doaj_org_article_c7679fe198ba40199f5dec81cdb20f4c&rfr_iscdi=true |