Akkermans M D, Uijterschout L, Vloemans J, Teunisse P P, Hudig F, Bubbers S, Verbruggen S, Veldhorst M, de Leeuw T G, van Goudoever J B, Brus F
a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands.
b Department of Clinical Chemistry , LabWest, Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands.
Pediatr Hematol Oncol. 2015;32(8):624-32. doi: 10.3109/08880018.2015.1085935. Epub 2015 Nov 11.
Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5-3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2-6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.
早期发现幼儿缺铁（ID）和缺铁性贫血（IDA）对于预防神经发育受损至关重要。不幸的是，许多ID生物标志物受感染影响，因此限制了它们的实用性。本研究旨在探讨红细胞分布宽度（RDW）和血小板计数在检测健康儿童ID（A）中的价值。在荷兰进行了一项多中心前瞻性观察研究，以调查400名0.5至3岁健康儿童中ID（A）的患病率。ID定义为在无感染（C反应蛋白[CRP]<5mg/L）时血清铁蛋白（SF）<12μg/L，IDA定义为血红蛋白<110g/L并伴有ID。在全血细胞计数中测定RDW（%）和血小板计数。RDW与SF呈负相关，与CRP无关。计算出的用于检测ID和IDA的RDW临界值敏感性相对较低（分别为53.1%和57.1%），特异性也较低（分别为64.7%和69.9%）。与RDW<14.3%的贫血儿童相比，RDW>14.3% 的贫血儿童缺铁的几率高2.7倍（95%置信区间[CI]：1.2 - 6.3））。ID儿童和非ID儿童的血小板计数范围都很大。总之，RDW有助于识别0.5至3岁儿童贫血的ID病因，但不能作为ID（A）的主要生物标志物。RDW值不受感染存在的影响。在这组儿童中，血小板计数在诊断ID（A）方面似乎没有作用。
