ORIGINAL ARTICLE

The diagnosis of borderline iron deficiency: results of a therapeutic trial

C M Wright¹, J Kelly², A Trail², K N Parkinson², G Summerfield³

¹ Department of Child Health, University of Glasgow, Glasgow, UK
² Department of Child Health, University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK
³ Department of Haematology, Queen Elizabeth Hospital, Gateshead, UK

Correspondence to:
Correspondence to:
C M Wright
Department of Child Health, University of Glasgow, Glasgow, UK; charlotte.wright{at}clinmed.gla.ac.uk

Background: Iron deficiency is common in early childhood and has been associated with developmental delay. It is not known how reliably markers of iron deficiency identify true iron deficiency, defined as a therapeutic response to oral iron.

Methods: The subjects were members of the Millennium Baby Study cohort. At age 13 months a venous blood sample was taken for mean cell volume (MCV), haemoglobin, mean cell haemoglobin (MCH), ferritin, and zinc protoporphyrin (ZPP). Children with abnormal values were offered treatment with oral iron and dietary modification, and re-sampled after 3 months.

Results: Samples were obtained for 462 children. All markers were moderately correlated with each other except ferritin. Treatment was offered to 147 (32%) children with at least one abnormal value, of whom 126 (86%) were re-sampled. Children with a haemoglobin or an MCH below the screening cut off, or with abnormal values for two or more of the remaining three measures, showed a large therapeutic response to iron, but isolated abnormalities of MCV, ZPP, or ferritin were not consistently associated with a response. Of the screened population 13% could be defined as iron deficient (abnormal haemoglobin or MCH, or abnormal levels of two or more of the remaining three markers), but this was not strongly associated with any dietary, demographic, or anthropometric characteristic.

Conclusions: Low total or mean cell haemoglobin in isolation is a specific marker of iron deficiency, but other markers are only predictive when found in combination with other abnormal values.

Abbreviations: MCH, mean cell haemoglobin; MCV, mean cell volume; NDNS, National Diet and Nutrition Survey; TRS, therapeutic response score; ZPP, zinc protoporphyrin

Keywords: anaemia; child; intervention study; iron deficiency; nutrition

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This article has been cited by other articles:

• White, K. C. (2005). Anemia Is an Important Finding and Is Likely to Respond to Iron Therapy: In Reply. Pediatrics 116: 1259-1259 [Full Text]  
• Wright, C. M., Summerfield, G. P., Moy, R. (2005). Anemia Is an Important Finding and Is Likely to Respond to Iron Therapy. Pediatrics 116: 1258-1259 [Full Text]  
• Jolobe, O M (2005). Diagnosis of iron deficiency anaemia. Arch. Dis. Child. 90: 653-654 [Full Text]