Department of Pediatrics, Torrecárdenas Hospital, Hermandad de Donantes de Sangre s/n, 04009, Almería, Spain.
Department of Pediatrics, Poniente Hospital, Avenida Almerimar s/n, 04007, El Ejido, Spain.
Eur J Pediatr. 2019 Jan;178(1):41-49. doi: 10.1007/s00431-018-3257-0. Epub 2018 Sep 27.
This cross-sectional study, conducted on a population-based representative sample, evaluates the usefulness of reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin (sTfR-F index) to recognise iron deficiency (ID) without anaemia, provides specific cut-off points for age and gender, and proposes a new definition of ID. A total of 1239 healthy children and adolescents aged 1-16 years were included. Complete blood count, iron biomarkers, erythropoietin, C-reactive protein, CHr, sTfR, and sTfR-F index were determined. ROC curves were obtained and sensitivity, specificity, predictive values, likelihood ratios, and accuracy for each specific cut-off points were calculated. Seventy-three had ID without anaemia. Area under the curve for sTfR-F index, sTfR and CHr were 0.97 (CI95% 0.95-0.99), 0.87 (CI95% 0.82-0.92) and 0.68 (CI95% 0.61-0.74), respectively. The following cut-off points defined ID: sTfR-F Index > 1.5 (1-5 years and 12-16 years boys) and > 1.4 (6-11 years and 12-16 years girls); sTfR (mg/L) > 1.9 (1-5 years), > 1.8 (6-11 years), > 1.75 (12-16 years girls) and > 1.95 (12-16 years boys); and CHr (pg) < 27 (1-5 years) and < 28.5 (6-16 years).Conclusions: CHr, sTfR and the sTfR-F index are useful parameters to discriminate ID without anaemia in children and adolescents, and specific cut-off values have been established. The combination of these new markers offers an alternative definition of ID with suitable discriminatory power. What is Known: • In adults, reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin index (sTfR-F index) have been evaluated and recognised as reliable indicators of iron deficiency (ID). • Clinical manifestations of ID may be present in stages prior to anaemia, and the diagnosis of ID without anaemia continues to pose problems. What is New: • CHr, sTfR and the sTfR-F index are useful parameters in diagnosis of ID in childhood and adolescence when anaemia is not present. • We propose a new strategy for the diagnosis of ID in childhood and adolescence, based on the combination of these measures, which offer greater discriminatory power than the classical parameters.
这项基于人群代表性样本的横断面研究评估了网织红细胞血红蛋白含量 (CHr)、血清转铁蛋白受体 (sTfR) 和 sTfR/铁蛋白比值 (sTfR-F 指数) 在识别无贫血的缺铁 (ID) 方面的有用性，为年龄和性别提供了特定的截断值，并提出了 ID 的新定义。共纳入 1239 名 1-16 岁的健康儿童和青少年。测定全血细胞计数、铁生物标志物、促红细胞生成素、C 反应蛋白、CHr、sTfR 和 sTfR-F 指数。获得 ROC 曲线，并计算每个特定截断值的敏感性、特异性、预测值、似然比和准确性。73 例 ID 无贫血。sTfR-F 指数、sTfR 和 CHr 的曲线下面积分别为 0.97(95%CI 0.95-0.99)、0.87(95%CI 0.82-0.92)和 0.68(95%CI 0.61-0.74)。以下截断值定义为 ID：sTfR-F Index > 1.5(1-5 岁和 12-16 岁男孩)和 > 1.4(6-11 岁和 12-16 岁女孩)；sTfR(mg/L) > 1.9(1-5 岁)、> 1.8(6-11 岁)、> 1.75(12-16 岁女孩)和 > 1.95(12-16 岁男孩)；CHr(pg) < 27(1-5 岁)和 < 28.5(6-16 岁)。结论：CHr、sTfR 和 sTfR-F 指数可用于鉴别儿童和青少年无贫血性缺铁，且已建立了特定的截断值。这些新标志物的联合使用提供了一种具有适当判别力的 ID 替代定义。已知：在成人中，网织红细胞血红蛋白含量 (CHr)、血清转铁蛋白受体 (sTfR) 和 sTfR/铁蛋白比值指数 (sTfR-F 指数) 已被评估并被认为是缺铁 (ID) 的可靠指标。在出现贫血之前，ID 的临床表现可能已经处于不同阶段，因此 ID 无贫血的诊断仍然存在问题。新内容：CHr、sTfR 和 sTfR-F 指数是诊断儿童和青少年无贫血性 ID 的有用参数。我们提出了一种新的 ID 诊断策略，基于这些措施的联合应用，比传统参数具有更高的判别能力。
