Abstract
BackgroundCurrent strategy to identify iron deficiency anemia relies on markers involving high costs. Reports have suggested red cell distribution width (RDW) as a potential screening test for identifying iron deficiency anemia (IDA) but studies in pediatric populations are lacking. Our study elucidates the discriminative ability of RDW for detecting IDA among young children.Methods2091 blood reports of children aged 1–3 years from an urban low socio-economic population of Delhi were analyzed to evaluate the sensitivity of RDW in discriminating IDA using receiver’s operating characteristic curve. Hemoglobin and RDW were estimated using coulter, zinc protoporphyrin with AVIV fluorometer and serum ferritin by enzyme linked immunosorbent assay.ResultsA total of 1026 samples were classified as iron deficient anemia using gold standard. As a marker of overall efficiency, area under the curve for RDW was 0.83 (95% CI, 0.81- 0.84; p < 0.001). Sensitivity of RDW at cut-off of 18% to detect iron deficiency anemia was 76.5% and specificity 73.1% yielding a positive predictive value of 73% and negative predictive value of 76%. At a cut-off of RDW 16.4%, the sensitivity was 94% and at a cut-off of 21%, the specificity was 95%. Combination of hemoglobin ≤10 g/dL and RDW >15%, yielded a sensitivity of 99% and specificity of 90%. These data suggest that simple coulter analysis estimating hemoglobin and RDW can be used for identification of children in need for iron therapy.ConclusionsIn India and similar settings, RDW >15% with hemoglobin ≤10.0 g/dL identifies iron deficient anemic children without need for iron status markers which could help reduce cost of management especially in poor settings.Trial registrationClinicaltrials.gov NCT00255385.
Highlights
Current strategy to identify iron deficiency anemia relies on markers involving high costs
The detection of iron deficiency anemia (IDA) is largely dependent upon quantification of biochemical markers like serum ferritin (SFr), serum transferrin (STr) and zinc protoporphyrin (ZnPP) which are not routinely available and affordable in developing countries due to high costs
Studies have shown that red cell distribution width (RDW) in addition to other hematological markers like mean corpuscular volume (MCV) and hemoglobin can be used as a differential diagnostic tool for identification of iron deficiency anemia [7,8,9]
Summary
Current strategy to identify iron deficiency anemia relies on markers involving high costs. Various studies show that the onset of iron deficiency anemia can be predicted using automated blood analyzers [7], as a low haemoglobin level along with a high level of anisocytosis detectable by red cell distribution width prove to be good indicators of changes in blood due to depleted iron stores [8] It seems that the earliest hematological manifestation of iron deficiency is marked by an elevated level of RDW [9] and reports have shown that it is a cost-effective screening tool for early diagnosis of IDA in comparison to SFr and ZnPP [9,10,11]. In the present study we evaluated the discriminative ability of RDW diagnostic test for detecting iron deficiency anemia among children aged 1–3 yrs in a low socio-economic setting using receiver’s operating characteristic curve (ROC) analyses
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