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Zinc protoporphyrin/heme ratio for diagnosis of preanemic iron deficiency
R L Rettmer1, T H Carlson, M L Origenes
1Department of Laboratory Medicine, University of Washington, Seattle, Washington 98195, USA.
Insights
The zinc protoporphyrin/heme (ZPP/H) ratio effectively screens for iron deficiency before anemia develops in children. This sensitive and specific test is valuable in pediatric practices for early detection and management of iron status.
Area of Science:
- Pediatric Health
- Nutritional Science
- Clinical Laboratory Science
Background:
- Iron deficiency anemia negatively impacts cognitive and psychomotor development in children.
- The zinc protoporphyrin/heme (ZPP/H) ratio is a sensitive indicator of early iron depletion, preceding anemia.
- Evaluating the ZPP/H ratio in primary pediatric care is crucial for early detection.
Purpose of the Study:
- To assess the utility of the ZPP/H ratio as a screening tool for iron deficiency in a pediatric practice.
- To compare the ZPP/H ratio's effectiveness against traditional iron status markers.
Main Methods:
- Screened iron status in 361 children using hemoglobin, hematocrit, serum transferrin saturation, ferritin, and ZPP/H ratio.
- Evaluated the ZPP/H ratio as a standalone indicator for detecting iron deficiency onset and monitoring recovery.
- Analyzed age- and sex-related variations in ZPP/H ratio.
Main Results:
- The ZPP/H ratio and serum ferritin independently identified 3%-4% of iron-deficient patients, showing higher specificity than hemoglobin or hematocrit.
- Concordance of three iron status parameters reduced the predicted iron deficiency prevalence to ≤1%.
- Children under 3 years and adolescent girls exhibited significantly higher ZPP/H ratios.
Conclusions:
- Iron deficiency without anemia is common in certain pediatric developmental stages, despite low anemia prevalence.
- The ZPP/H ratio is a sensitive, specific, and cost-effective method for identifying preanemic iron deficiency in pediatric settings.
- This test aids in managing iron status and supporting healthy child development.
Objective:
Iron deficiency anemia is known to impair cognitive and psychomotor development. The zinc protoporphyrin/heme (ZPP/H) ratio is a simple, accurate, and sensitive laboratory screening test that detects early iron depletion before the onset of anemia. The objective of this work was to evaluate this test in a primary pediatric practice setting.
Methods:
The iron status of a cohort of 361 children was screened during routine examinations at a community pediatric practice. Whole blood hemoglobin concentration, hematocrit ratio, serum transferrin saturation, ferritin concentration, and the ZPP/H ratio were measured. The ZPP/H ratio then was evaluated as a single indicator of iron status by comparing it with other tests for detecting the onset of iron deficiency and for monitoring recovery after iron supplementation.
Results:
Significant age- and sex-related differences in the ZPP/H ratio were found. In this cohort, serum ferritin concentration and the ZPP/H ratio independently identified the same fraction of iron-deficient patients (3%-4%), and both tests were more specific than was either hemoglobin or hematocrit. A concordance of three iron status parameters changed the prediction of iron deficiency to
Conclusion:
The prevalence of iron deficiency anemia in the typical healthy American pediatric population is low, but iron deficiency without anemia remains relatively common at some stages of development. Increase in the ZPP/H ratio is demonstrated to be a sensitive, specific, and cost-effective test for identifying preanemic iron deficiency in a community pediatric practice. anemia, nutrition, development.
