Biondich Paul G, Downs Stephen M, Carroll Aaron E, Laskey Antoinette L, Liu Gilbert C, Rosenman Marc, Wang Jane, Swigonski Nancy L
Children's Health Services Research, Indianapolis, Indiana, USA.
Pediatrics. 2006 Feb;117(2):290-4. doi: 10.1542/peds.2004-2103.
Screening for iron deficiency anemia is a well-established practice in pediatrics, but numerous challenges surrounding current recommendations raise questions about the effectiveness of this strategy.
To evaluate iron deficiency anemia screening approaches, by assessing rates of follow-up testing and resolution among patients meeting screening criteria in a primary care setting.
A retrospective cohort study was performed. We extracted electronic medical record data on complete blood counts for infants who received primary care in our clinics in the past 10 years. We calculated rates of positive screening results with 9 different measurement criteria and determined rates of follow-up testing and of documented correction of iron deficiency among those who screened positive.
Our cohort consisted of 4984 children who were screened at 9 to 15 months of age, between 1994 and 2004. There was a wide distribution of positive detection rates (range: 1.5-14.5%) among the 9 screening criteria. Follow-up testing rates were low. No more than 25% of infants who screened positive by any criterion underwent a repeat complete blood count within 6 months. Moreover, no more than 11.6% (range: 4.4-11.6%) had documented correction of their laboratory abnormalities.
Significant shortcomings exist in current iron deficiency anemia screening practices. A widely agreed-on, specific, and inexpensive screening criterion, with increased emphasis on systems-based approaches to iron deficiency screening, is needed.
缺铁性贫血筛查是儿科领域一项既定的做法，但围绕当前建议存在诸多挑战，这引发了对该策略有效性的质疑。
通过评估初级保健机构中符合筛查标准的患者的后续检测率和康复率，来评价缺铁性贫血筛查方法。
进行了一项回顾性队列研究。我们提取了过去10年在我们诊所接受初级保健的婴儿的全血细胞计数电子病历数据。我们用9种不同的测量标准计算了阳性筛查结果的发生率，并确定了筛查呈阳性者的后续检测率和缺铁记录纠正率。
我们的队列包括1994年至2004年间9至15个月大时接受筛查的4984名儿童。在9种筛查标准中，阳性检出率分布广泛（范围：1.5 - 14.5%）。后续检测率较低。通过任何标准筛查呈阳性的婴儿中，在6个月内进行重复全血细胞计数的不超过25%。此外，记录显示实验室异常得到纠正的不超过11.6%（范围：4.4 - 11.6%）。
当前缺铁性贫血筛查实践存在重大缺陷。需要一个广泛认可、具体且廉价的筛查标准，同时更加强调基于系统的缺铁筛查方法。
