608 Prevalence of iron deficiency anaemia in children undergoing autism assessment

Abstract

<h3>Aims</h3> Autism is associated with disordered eating behaviours, including avoidant and restrictive patterns, which can lead to nutritional deficiency. Iron is the most common mineral deficiency and can lead to iron deficiency anaemia (IDA) when severe. IDA is known to cause significant problems with behaviour, cognition, attention and sleep - difficulties which are often present in autistic children. IDA is easily treatable with supplementation In this study, we aimed to assess the prevalence of iron deficiency and resulting IDA in children who have had bloods as part of an autism assessment, assessing the association with age, sex, social deprivation and clinical presentation. <h3>Methods</h3> We retrospectively reviewed blood tests for 87 children (aged 1-17 years; median 4 years 6 months, interquartile range (IQR) 5 years), between June 2019 and September 2021 in North Bristol. Iron deficiency anaemia was defined using WHO guidelines: Haemoglobin of &lt;110 g/l under 5 years; &lt;115g/dl in children aged 5-12 years and &lt;120g/l in children over 12 years; in combination with a serum ferritin &lt;15ug/l. Family postcode was used to create a patient’s index of multiple deprivation decile using the Office for National Statistics (ONS) registry. A Mann-Whitney U test was used to compare distributions between groups and a Chi squared/Fisher’s exact test used for proportions. <h3>Results</h3> Anaemia was found in 7/87 cases (8%) of which 5/87 (6%) were identified as having IDA. Iron deficiency was seen in 10/84 (12%) of the cohort. There was a significant difference in age between those children with and without IDA (Median 2.91 years (IQR 1) vs 4.63 years (IQR 5) respectively p=0.038) and iron deficiency (Median 3.3 years (IQR 1) vs Mean 4.8 years (IQR 6) p=0.031) (figure 1). All children with iron deficiency were at a preschool age and within this group the prevalence of IDA increased to 5/48 (10%) with iron deficiency present in 9/47 (19%). We found a that there was a significantly lower social deprivation decile (i.e. children came from more socially deprived areas) in cases of IDA, with all these children coming from the most deprived 20% of the UK population (Median decline 1 (IQR 1) vs median 3 (IQR 4) p=0.014) A significant difference was also seen in iron deficiency cases. (Median 1 (IQR 2) vs 3 (IQR 4) p=0.007) (figure 2). There was no significance difference between sex distributions for either iron deficiency or IDA. We found no association with the presence of co-morbid ADHD, Sleep disorders or developmental delay and the presence of IDA. <h3>Conclusion</h3> This study shows that Iron deficiency is common in this cohort. Particularly in preschool children, with 19% identified to be iron deficient and 10% anaemic as a result. The reasons for autistic children developing iron deficiency are complex and not fully understood. Our study found a significant association with social deprivation. This study is limited by being a retrospective design based on a single locality’s practice. A prospective study of IDA in autism would give stronger evidence and could help conclude if screening and treatment for IDA in autistic preschool children can improve functional outcome.