Diagnosis of Iron Deficiency in Pregnancy

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Hematological Disorders

Indicators for Anemia & Iron Deficiency

Hematological Disorders in Children

Anemia

Approach To A Bleeding Child

Hemophilia

Congenitial Immunodeficiency Detecting Guidelines

Red Cell Substitutes

Idiopathic Thrombocytopenic purpura in children

Hemoglobin Variants Detection by High Performance Liquid Chromatography Method

Platelet Transfusion Facts

Hematological manifestations of systemic illness

Thalassemia

Administration of Blood

Aplastic Anemia

Significance of Karyotyping in Childhood Acute Lymphoblastic Leukemia

Clinical Tools

Clinical Vignettes

Diseases & Conditions

Drugs Interaction Calculator

Podcasts

Patient Management Online

Diagnostic Dilemma

Question of the Day

Diagnostic Aid

VACCINE REMINDER

"Get the Vaccine Schedule for your child."

Ask Queries

SPECIALIST ANSWERS

Today's Poll

Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

Vote

Results

INDICATORS FOR ASSESSMENT OF ANEMIA AND IRON DEFICIENCY IN COMMUNITY

Indicators for Anemia and Iron Deficiency

Related Topics

Summary

Methods of Assessing Iron Status

K N Agarwal
Indian National Science Academy & Health Care & Research Association for Adolescents

Address for correspondence

Dr K N Agarwal, President,
Health Care & Research Association for Adolescents;
D-115, Sector-36 Noida, Gautam Budha Nagar, UP, India-201301.
Email: adolcare@hotmail.com

Methods of assessing iron status :

Diagnosis of iron deficiency in pregnancy :

Hemoglobin level of <11.0g/dl in 1st and 3rd trimester and <10.5g/dl in 2nd trimester is recommended as cut off for anemia, by the American Centre for Disease Control and Prevention.
MCV is raised in pregnancy (whether iron deficiency or not).
Serum ferritin falls in 2nd and 3rd trimesters with or without iron deficiency.
TIBC and serum iron- have sensitivity in pregnancy.
EPP - fluctuates less in pregnancy.
Serum transferrin receptor test is sensitive and is not affected in pregnancy.

Conclusion:

To summarize in India we have situation of wide spread anemia and infection at all ages. Anemia is most likely due to iron and/or folate deficiencies. Vitamin B12 deficiency is also common in younger age group. Hemoglobin estimation, peripheral smear and therapeutic response to iron are good time tested tools and should be used first in diagnosis of iron deficiency. In view of high prevalence of anemia to detect iron deficiency, community level screening is recommended.

A.		Universal Screening : - Clinical assessment - Hemoglobin estimation and peripheral smear to exclude hem parasite(s) - Clinical response to iron administration - Stool examination- to exclude worm infestation and 'Hem occult' blood test.
B.		Selective screening for an individual: To confirm diagnosis of iron deficiency additional tests suggested are serum ferritin (with negative CRP) and tranferrin receptor (calculate TfR index) (27,28).

The subject of iron deficiency and search for ideal tool in diagnosis has continued for over sixty years (34), for a simple and reliable test to diagnose early iron deficiency. The estimation of iron and ferritin in saliva need further exploration (31,35). The newer indices RDW, HyPom, CHr and Ret Y need studies in Indian population.

References:

Teoteja G, Singh P. Micronutrient deficiency disorders in 16 districts of India. Report of an ICMR Task Force Study - District Nutrition Project. Part 1. 2001.
Agarwal KN, Agarwal DK, Sharma A, Sharma K, Prasad K, Kalita MC, et al. Prevalence of anaemia in pregnant & lactating women in India. Indian J Med Res. 2006; 124: 173-184
Kapur D, Agarwal KN, Agarwal DK. Nutritional anemia and its control. Indian J Pediatr. 2002; 69: 607-616
Gomber S, Kumar S, Rusia U, Gupta P, Agarwal KN, Sharma S. Prevalence and etiology of nutritional anemias in early childhood in an urban slum. Indian J Med Res. 1998; 107: 269-273.
White KC. Anemia is a poor predictor of iron deficiency among toddlers in the United States. Pediatrics. 2005; 115: 315-320
Cook JD. Diagnosis and management of iron deficiency anemia. Best Pract Res Clin Haematol 2005; 18: 319-332.
Singla PN, Chand S, Agarwal KN. Cord serum and placental tissue iron status in maternal hypoferremia. Am J Clin Nutr. 1979; 32: 1462-1465
Agrawal RM, Tripathi AM, Agarwal KN. Cord blood haemoglobin, iron and ferritin status in maternal anaemia. Acta Paediatr Scand. 1983; 72: 545-548
Fransson GB, Agarwal KN, Gebre-Medhin M, Hambraeus L. Increased breast milk iron in severe maternal anemia: physiological "trapping" or leakage? Acta Paediatr Scand. 1985; 74: 290-291
Agarwal KN.. Iron and the brain: neurotransmitter receptors and magnetic resonance spectroscopy. Br J Nutr. 2001; 85 Suppl 2: S147-S150.
Adaman JW, Dan L. Anemia and polycythemia. Section-10 Hematological Alterations. In Harrison's Principles of Internal Medicine 16th ed. Vol. 1, editors Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL. McGraw Hill, N. Y. 2005; pp 334-336
WHO/CDC. Best indicators to assess iron deficiency, a major cause of anemia. 7th May 2004.
Glader B. Iron deficiency anemia. Chap. 447; Nelson's Text Book of Pediatrics 17th ed. Editors Behrman RE, Kleigman RM, Jenson HB. Elsevier India Pvt Ltd. New Delhi. 2004; pp 1614-1616.
Andrews NC. Disorders of iron metabolism. Chap 46. In Blood: Principles and Practice of Hematology. Editors Handin RI, Lux SE, Stossel TP. 2nd ed. Lippincott Williams & Wilkins. Philadelphia USA.2003; pp 1399-1433.
Perkins SL. Examination of the blood and bone marrow. Chapter 1. In Wintrobe's Clinical Hematology 11thed. Editors: Greer JP, Foerster J, Lukens JN, Roders GM, Paraskevas F, Glader B. Lippincott Williams & Wilkins, Philadelphia, USA. 2004; 1: 3-25
Hudson-Thomas M, Bingham KC, Simmons WK. An evaluation of HemoCue for measuring haemoglobin in field studies in Jamiaca. Bull World Health Organ 1994; 72: 423-426.
Reference and selected procedures for the qualitative determination of hemoglobin in blood approved standards 2nd ed. Villanova PA National Committee for Clinical Laboratory Standards 1994.
NFHS (2002) India 1998-99- National Family Health Survey-2 NFHS-2-Anemia among women and children. International Institute for Population, Sciences, Mumbai 2000.
Dacie JV, Lewis SM. Practical Hematology. Chapter 5; Basic Haematological techniques 7^th ed. Churchill Livingstone, London. 1991; pp 37-54.
Bhaskaram P, Balakrishna N, Radhakrishna KV, Krishnaswamy K. Validation of hemoglobin estimation using Hemocue. Indian J Pediatr. 2003; 70: 25-28
Garby L, Irnell L, Werner I. Iron deficiency in women of fertile age in a Swedish community. 3. Estimation of prevalence based on response to iron supplementation. Acta Med Scand. 1969; 185) :113-117
Reeves JD, Driggers DA, Lo EY, Dallman PR. Screening for iron deficiency anemia in one-year-old infants: hemoglobin alone or hemoglobin and mean corpuscular volume as predictors of response to iron treatment. J Pediatr. 1981; 98: 894-898
Srivastava PC. Differentiation of thalassaemia minor from iron deficiency. Lancet. 1973; 2: 154-155
Kickler TS, Borowitz MJ, Thompson RE, Charintranont N, Law R. Ret Y a measure of reticulocyte size: a sensitive indicator of iron deficiency anemia. Clin Lab Haematol. 2004; 26: 423-427
Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA. 1999; 281: 2225-2230
Radtke H, Meyer T, Kalus U, Rocker L, Salama A, Kiesewetter H, Latza R. Rapid identification of iron deficiency in blood donors with red cell indexes provided by Adiva 120. Transfusion. 2005; 45: 5-10
Cook JD. The measurement of serum transferrin receptor. Am J Med Sci. 1999; 318: 269-276
Suominen P, Punnonen K, Rajamaki A, Irjala K. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood. 1998; 92: 2934-2939
Margetic S, Topic E, Ruzic DF, Kvaternik M. Soluble transferrin receptor and transferrin receptor-ferritin index in iron deficiency anemia and anemia in rheumatoid arthritis. Clin Chem Lab Med. 2005; 43: 326-331.
Zimmermann MB, Molinari L, Staubli-Asobayire F, Hess SY, Chaouki N, Adou P, Hurrell RF. Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children. Am J Clin Nutr. 2005; 81: 615-623
Agarwal PK, Agarwal KN, Agarwal DK. Biochemical changes in saliva of malnourished children. Am J Clin Nutr. 1984; 39: 181-184
Routh BR, Agarwal KN. Estimation of tissue iron (non-haem iron) in Indian subjects. Indian J Med Res. 1967; 55: 1330-1336
Shukla A, Agarwal KN, Shukla GS. Effect of latent iron deficiency on metal levels of rat brain regions. Biol Trace Elem Res. 1989; 22: 141-152
Vahlquist BC. Das serum errisen, eine paediatrisch kinische und experimental studies. Acta Paediatr. 1941; 28:1-4
Mishra OP, Agarwal KN, Agarwal RM. Salivary iron status in children with iron deficiency and iron overload. J Trop Pediatr. 1992; 38: 64-67

Last updated on 01-06-2010 Vol 7 Issue 6 Art # 35

Advance Access on 01-06-2010

How to cite this url :

Agarwal KN. Indicators for Assessment of Anemia and Iron Deficiency in Community. Pediatric Oncall [serial online] 2010 [cited 2010 June 1];7. Art # 35. Available from:

Advance Access : 01^st June 2010

Mail To Your Friend

Print This Article

Diseases & Conditions

Pediatric Oncall Journal

Case Reports

Original Research

Letter to Editor