Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O
Department of Pathology, The Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
JAMA. 1999 Jun 16;281(23):2225-30. doi: 10.1001/jama.281.23.2225.
Early identification of iron deficiency in children is essential to prevent the damaging long-term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for iron deficiency and iron deficiency anemia in children.
To develop an effective approach for the diagnosis of iron deficiency and iron deficiency anemia in young children.
Retrospective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis.
A total of 210 children (mean [SD] age, 2.9 [2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician.
Levels of hemoglobin (Hb), iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor and reticulocyte Hb content (CHr) among patients with and without iron deficiency, defined as Tfsat of less than 20%, and iron deficiency anemia, defined as Tfsat of less than 20% and Hb level of less than 110 g/L.
Of the 210 subjects, 43 (20.5%) were iron deficient; 24 of these had iron deficiency anemia. Reticulocyte Hb content and Hb levels were the only significant predictors of iron deficiency (likelihood ratio test [LRT] = 15.96; P<.001 for CHr, and LRT = 6.59; P = .01 for Hb), and CHr was the only significant multivariate predictor of iron deficiency anemia (LRT = 30.43; P<.001). Plasma ferritin level had no predictive value (P = .97). Subjects with CHr of less than 26 pg (optimal cutoff value based on sensitivity/specificity analysis) had lower Hb level, mean corpuscular volume, mean corpuscular Hb level, serum iron level, and Tfsat, and increased red blood cell distribution width vs those with CHr of 26 pg or more (P<.001 for all).
Reticulocyte Hb content level was the strongest predictor of iron deficiency and iron deficiency anemia in children. It holds promise as an alternative to biochemical iron studies in diagnosis.
早期识别儿童缺铁对于预防该疾病造成的长期损害后果至关重要。然而，尚不清楚儿童缺铁和缺铁性贫血的诊断指标应包括哪些。
制定一种诊断幼儿缺铁和缺铁性贫血的有效方法。
1996年进行了为期7周的回顾性实验室分析，使用儿科医生开出并送往一家大型都市医院进行分析的血样。
共有210名儿童（平均[标准差]年龄，2.9[2.0]岁；120名男性），他们接受了初级保健儿科医生开出的铅筛查测试（全血细胞计数和血浆铅水平）。
缺铁（定义为转铁蛋白饱和度低于20%）和缺铁性贫血（定义为转铁蛋白饱和度低于20%且血红蛋白水平低于110g/L）患者与非患者的血红蛋白（Hb）、铁、转铁蛋白、转铁蛋白饱和度（Tfsat）、铁蛋白、循环转铁蛋白受体和网织红细胞血红蛋白含量（CHr）水平。
在210名受试者中，43名（20.5%）缺铁；其中24名患有缺铁性贫血。网织红细胞血红蛋白含量和血红蛋白水平是缺铁的唯一显著预测指标（似然比检验[LRT]=15.96；CHr的P<0.001，LRT=6.59；Hb的P=0.01），CHr是缺铁性贫血的唯一显著多变量预测指标（LRT=30.43；P<0.001）。血浆铁蛋白水平无预测价值（P=0.97）。CHr低于26pg（基于敏感性/特异性分析的最佳临界值）的受试者与CHr为26pg或更高的受试者相比，血红蛋白水平、平均红细胞体积、平均红细胞血红蛋白水平、血清铁水平和转铁蛋白饱和度更低，红细胞分布宽度增加（所有P<0.001）。
网织红细胞血红蛋白含量水平是儿童缺铁和缺铁性贫血的最强预测指标。它有望作为生化铁研究诊断的替代方法。
