Serum ferritin to detect iron deficiency in children below five years of age
Keywords:
iron deficiency, serum ferritin, soluble transferrin receptor
Abstract
Background Iron deficiency (ID) anemia impacts thecognitive and motor development of children until the age of
10 years, despite receiving iron therapy. Early det ection of ID
is recommended and serum ferritin has been proposed as an
alternative indicator for ID det ection.
Objective To assess th e diagnostic accuracy of serum ferritin for
detecting ID in children below five years of age.
Methods T his cross-sectional, diagnostic study was conducted in
primary health care centers in Yogyakarta and Bantu!. Hemoglobin
(Hb), serum ferritin and soluble transferrin receptor (sTfR) levels
were performed on children aged 6- 59 months.A sTfR level of 2:
8.2 mg/L was used to define iron deficiency. T he best cutoff point
for serum ferritin level use as a diagnostic tool was determined by
receiver operator curve.
Results T he prevalence ofID was32%. Mean h emoglobin levels
in iron deficient and healthy children were 11.7 (SD 0.5) g/dL and
12.2 (SD 0.7) g/dL, respectively. T he sensitivity, specificity, and
positive predictive value (PPV) of serum ferritin ( < 12 ug/L) were
17%, 93%, and 56%, respectively. Using a cut off of <32.4 ug/L,
serum ferritin had sensitivity of 62. l % and specificity of 50.8%.
Conclusions The diagnostic value of serum fe rritin levels is
modestly capable of detecting ID. Therefore, serum ferritin should
not be used as an alternative indicator for detecting ID in children
below five years of age.
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Indon esian Pediatric Society; 2009 [cited 2012 May 9].
Available from: http://www.idai .or.id/kesehatananak/artikel.
asp?q=201257959 I I
3 . Sutaryo. Tujuh puluh lima persen anak di DIY menderita
anemia defisiensi besi. Suara merdeka; 2007 [cited 2012
May 9]. Available from: http://www.suaramerdeka.com/
cybemews/harian/07 05/08/dar3 .htm
4. Soedjatmiko. Pengaruh defisiensi besi t erhadap kecerdasan
clan perilaku anak. In: PKB LII Departemen Ilmu Kesehatan
Anak Fakultas Kedokteran Universitas Indonesia. Pendekatan
praktis pucat. Jakarta: Indonesian Pediatric Society; 2007. p.
72-86.
5. Wu AC, Lesperance L, Bernstein H. Screening for iron
deficiency. Pediatr Rev. 2002;23: 171-8.
6. Vendt N, Talvik T, Leedo S, Tomberg K, Kool P, Tillmann V,
et al. The reference limits and cut-off value for serum soluble
transferrin receptors for diagnosing iron deficiency in infants.
Int J Lab Hematol. 2009;31 :440-6.
7. Koulaouzidis A, Said E, Cotter R, Saeed AA. Soluble
transferrin receptors and iron deficiency, a step beyond
ferritin. A systematic review. J Gastrointestin Liver Dis.
2009; 18 :345-52.
8. Muhammad A, Sianopar 0. Penentuan defi siensi besi, anemia penyakit kronis menggunakan peran indeks
sTfR-F. Indonesian Journal Clinical Pathology and Medical
Laboratory. 2005;12:9-16.
9. Baker RD, Greer FR, and the Committee on Nutrition
American Academy of Pediatrics. Diagnosis and prevention
of iron deficiency and iron deficiency anemia in infants and
young children (0-3 years ofage). Pediatrics. 2010; 126: 1040-
50.
10. Erhardt JG, Estes JE, Pfeiffer CM, Biesalski HK, Craft NE.
Combined measurement of ferritin, soluble transferrin
receptor, retinol binding protein, and C-reactive protein by an
inexpensive, sensitive, and simple sandwich enzyme-linked
immunosorbent assay technique. J Nutr. 2004; 134:3127-
32.
11. New social economy status bracket. Indonesia: Nielsen Co.;
2010. p. 1-4.
12. Iron deficiency anemia. Assessment, prevention, and control.
A guide for programme managers. Geneva: WHO; 2001. p.
1-132.
13. Kaza! L. Prevention ofiron deficiency in infant and toddlers.
Am Fam Physicians. 2002;66:1217-27.
14. Lanzkowsky P. Iron deficiency anemia. In: Manual of pediatric
hematology and oncology. 4,h ed. Amsterdam: Elsevier
Academic Press; 2 005 . p. 3 1-46.
15. Badham J, Zimmermann MB, Kraemer K. The guidebook
nutritional anemia. Urbana: Side and Life Press. 2007. p.
1-5 2.
16. Ayoya MA, Spiekermann-Brouwer GM, Stoltzfus RJ, Nemeth
E, Habicht JP, Ganz T, et al. al-Acid glycoprotein, hepcidin,
C-reactive protein, and serum ferritin are correlated in
anemic schoolchildren with Schistosoma haematobium. Am J
Clin Nutr. 2010;91:1784-90.
17. Ong KH, Tan HL, Lai HC, Kuperan P. Accuracy of various
iron parameters in the prediction of iron deficiency in an
acute care hospital. Ann Acad Med Singapore. 2005 ;34:43 7 -
40.
18. Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott
MG. Clinical utility of the soluble transferrin receptor and
comparison with serum ferritin in several populations. Clin
Chem. 1998;44:45-51.
19. Vendt N, Talvik T, Leedo S, Tomberg K, Kool P, Tillmann V,
et al. Reference and cut-off values for serum ferritin, mean
cell volume, and hemoglobin to diagnose iron deficiency in
infants aged 9 to 12 months. Medicina (Kaunas) . 2007;43: l-
5.
20. Sastroasmoro S, Ismael S, editors. Dasar-dasar metodologi
penelitian klinis. Jrd ed. Jakarta: Sagung Seto. 2008.
Published
2013-06-30
How to Cite
1.
Apriyanti W, Sutaryo S, Mulatsih S. Serum ferritin to detect iron deficiency in children below five years of age. PI [Internet]. 30Jun.2013 [cited 24Nov.2024];53(3):150-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/272
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-06-30
Accepted 2016-08-21
Published 2013-06-30
