Abstract
BackgroundIron deficiency anaemia is a common paediatric problem worldwide, with significant neurodevelopmental morbidity if left untreated. A decrease in the mean corpuscular volume (MCV) can be used as a surrogate marker for detecting early iron deficiency prior to definitive investigation and treatment. An audit cycle was therefore undertaken to evaluate and improve the identification, follow-up and treatment of abnormally low MCV results amongst the paediatric inpatients in an English district general hospital.MethodsThe audit cycle was performed retrospectively over two three-month periods (February to April 2006; September to November 2006), amongst patients aged between one month and 16 years that had full blood counts performed whilst admitted on the paediatric ward. Patients with at least one abnormally low MCV result were identified, and their notes reviewed. We looked for any underlying explanation for the result, adequate documentation of the result as abnormal, and instigation of follow-up or treatment. In-between the two audit periods, the results of the first audit period were presented to the medical staff and suggestions were made for improvements in documentation and follow-up of abnormal results. The z-test was used to test for equality of proportions between the two audit samples.ResultsOut of 701 inpatients across both audit periods that had full blood counts, 61 (8.7%) had a low MCV result. Only 15% of patients in each audit period had an identifiable explanation for their low MCV values. Amongst the remaining 85% with either potentially explicable or inexplicable results, there was a significant increase in documentation of results as abnormal from 25% to 91% of cases between the first and second audit periods (p = 0.00 using z-test). However, there was no accompanying increase in the proportion of patients who received follow-up or treatment for their abnormal results.ConclusionAbnormal red cell indices that may indicate iron deficiency are frequently missed amongst paediatric inpatients. Medical staff education and the use of appropriate protocols or pathways could further improve detection and treatment rates in this setting.
Highlights
Iron deficiency anaemia is a common paediatric problem worldwide, with significant neurodevelopmental morbidity if left untreated
A decrease in mean corpuscular haemoglobin (MCH), reflecting red cell hypochromia, can be used to diagnose iron deficiency; since this decrease normally accompanies the reduction in mean corpuscular volume (MCV) [8], it is no more reliable a marker than the MCV for detecting iron deficiency
With the exception of anaemia of chronic disease (ACD), other conditions that cause a microcytic, hypochromic anaemia are much rarer than iron deficiency, and other factors in the history and clinical picture will usually indicate if further testing is necessary
Summary
Iron deficiency anaemia is a common paediatric problem worldwide, with significant neurodevelopmental morbidity if left untreated. A decrease in the mean corpuscular volume (MCV) can be used as a surrogate marker for detecting early iron deficiency prior to definitive investigation and treatment. The incidental detection of an isolated low mean corpuscular volume (MCV) result could indicate early iron deficiency that has not yet resulted in anaemia. Previous work has suggested that this type of illness can lead to a transient decrease in Hb, there is little or no significant change in the MCV [10,11]. This anaemia can take up to three months to resolve, depending on the level of inflammation associated with the illness [12]. The red cell distribution width (RDW) can help to differentiate ACD from iron-deficiency anaemia, since this is abnormally elevated in iron-deficiency anaemia, but not in ACD [13]
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