Mentzer index as a screening tool for iron deficiency anemia in 6-12-year-old children

Sri Lestari S. Alam; Rini Purnamasari; Erial Bahar; Kemas Ya'kub Rahadian

doi:10.14238/pi54.5.2014.294-8

Sri Lestari S. Alam Departments of Child Health, Sriwijaya Medical School/Dr. Moh. Hoesin Hospital, Palembang, South Sumatera
Rini Purnamasari Departments of Child Health, Sriwijaya Medical School/Dr. Moh. Hoesin Hospital, Palembang, South Sumatera
Erial Bahar Departments of Biostatistic, Sriwijaya Medical School/Dr. Moh. Hoesin Hospital, Palembang, South Sumatera
Kemas Ya'kub Rahadian Departments of Clinical Pathology, Sriwijaya Medical School/Dr. Moh. Hoesin Hospital, Palembang, South Sumatera

DOI: https://doi.org/10.14238/pi54.5.2014.294-8

Keywords: iron deficiency anemia, IDA, Mentzer index, serum ferritin

Abstract

Background There is a high prevalence of iron deficiency anemia (IDA) in Indonesia. Iron deficiency anemia impairs the growth and development process in children. The reference standard to diagnose IDA is serum ferritin level. Since this test is expensive and rare not widely available, an inexpensive, simpler testis needed. The Mentzer index (mean corpuscular volume/red blood cell or MCV JRBC) has been used to identitY hypochromic-microcytic anemia with good validity.

Objective To assess the validity of the Mentzer index for diagnosing IDA by comparing Mentzer indexes to serum ferritin and to define an optimal Mentzer index cut off point with good sensitivity and specificity.

Methods The study was a diagnostic test with cross-sectional design. Subjects were collected by multistage, random sampling, from April to May 2013 at 18 elementary schools in Palembang. The study had a survey phase and diagnostic test phase. Subjects were aged 6-12 years with hypochromic-microcytic anemia. We examined complete blood counts to diagnose hypochromic-microcytic anemia, calculated Mentzer indexes, and measured serum ferritin levels of our subjects. We analyzed the validity of Mentzer index compared to serum ferritin level for diagnosing IDA.

Results There were 100 children in our study, consisting of 51boys and 49 girls with a mean age of 9.1 (SD 2.02) years. From the receiver-operator curve (ROC) curve analysis, the area under the curve (AUC) was 91.5)010 for a Mentzer index cutoff point of 13.51. Diagnostic test analysis revealed a sensitivity of93%, specificity 84 %, and accuracy 90%.

Conclusion Mentzer index has good validity as an inexpensive and simple screen for IDA in 6-12-year-old children with hypochromic-microcytic anemia.

References

Riset Kesehatan Dasar. Badan penelitian dan pengembang kesehatan. Departemen Kesehatan Republik Indonesia. 2007.

Dallman PR. Iron deficiency anemia: a synthesis of current scientific knowledge and U.S recommendation for prevention, detection and management among U.S children and women of childbearing age. 2004.

Ehsani MA , Shahgholi E, Rahiminejad MS, Seighali F, Rashidi A. A new index for discrimination between iron deficiency anemia and beta-thalassemia minor: results in 284 patients. Pak J Biol Sci. 2009;12:473-5.

Chronic disease prevention and health promotion. Stature for age and weight for age percentiles. May 30, 2000. http://www.cdc.growthcharts.

Glader B. Anemia: general considerations. In: Greer JP, Foerster J, Lukens IN, Rodgers GM, Paraskevas F, Glader B, editors. Wintrobe's clinical hematology. 11th ed. Philadelphia: Lippincott William & Wilkins; 2004. p.947-78

Dallman PR, SUmes 11A , Stekel A. Iron deficiency in infancy and childhood. Am J Clin Nutr. 1980;33:86-118.

Andrew NC. Iron deficiency and related disorders. In: Green JP, Foerster J, Lukens IN, Roclgers G11, Paraskevas F, Glader B, editors. Wintrobe's clinical hematology. 11th ed. Philadelphia: Lippincott William & Wilkins; 2004. p.979-1009.

Smith H. Normal values and appearance. In: Smith H, editor. Diagnosis in paediatric haematology. 1st ed. New York: Churchill Livingstone; 1996. p.1-33.

Walters GO, Miller FM, Worwood M. Serum ferritin concentration and iron stores in normal subjects. J Clin Pathol. 1973;26:770-2.

Soemantri AG. Epidemiology of iron deficiency anaemia. Yogyakarta, Indonesia: Medika-Fakultas Kedokteran UGM; 2005. p.8-28.

Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr Rev. 2002;23:171-8.

Leggett BA, Brown NN, Bryant SJ, Duplock L, Powell LW , Halliday JW. Factors affecting the concentrations of ferritin in serum in a healthy Australian population. Clin Chem. 1990;36:1350-5.

Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111:1805-12.

Domellof M, Lonnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hemell O. Sex differences in iron status during infancy. Pediatrics. 2002;110:545-52.

Batebi A, Pourreza A, Esmailian R. Discrimination of beta-thalassemia minor and iron defidency anemia by screening test for red blood cell indices. Turk J Med Sci. 2012;42:275-80.

Dahlan MS. Penelitian diagnostik: analisis penelitian diagnostik. 1st ed. Jakarta: Salemba Medika; 2009. p.19-30.

Pusponegoro HD, Wirya IGN W, Pudjiaji AH, Bisanto J, Zulkarnain SZ. Uji diagnostik. In: Sastroasmoro S, Ismael S, editors. Dasar-dasar metodologi penelitian klinis. 1st ed. Jakarta: Sagung Seto; 2008. p.193-216.