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Profile of bone marrow iron stores in childhood iron deficiency anemia
1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara.
Insights
Bone marrow iron stores are crucial for diagnosing iron deficiency (ID) in children. Even with low serum iron, bone marrow iron assessment aids diagnosis, especially in complex cases.
Area of Science:
- Pediatric Hematology
- Nutritional Science
- Diagnostic Medicine
Background:
- Iron deficiency (ID) is a common nutritional deficiency in children.
- Accurate diagnosis of ID is essential for timely intervention and management.
- Assessing iron status involves various laboratory parameters, but their interpretation can be challenging.
Purpose of the Study:
- To highlight the significance of bone marrow iron stores in diagnosing iron deficiency in children.
- To evaluate the utility of bone marrow iron assessment when other iron status indicators are equivocal.
- To determine the correlation between bone marrow iron stores and other hematological parameters in pediatric ID.
Main Methods:
- Analysis of complete hemogram, serum iron (SI), serum iron-binding capacity (SIBC), transferrin saturation (TS), and serum ferritin in 31 children with ID.
- Bone marrow aspiration and staining to assess bone-marrow-stored iron.
- Correlation of bone marrow iron findings with other laboratory results.
Main Results:
- All 31 children with iron deficiency exhibited zero bone marrow iron stores, indicating high sensitivity of this marker.
- Bone marrow iron stores are significantly affected in childhood iron deficiency.
- Diagnosis of ID can be challenging with low SI but normal SIBC, or in the presence of chronic inflammatory diseases.
Conclusions:
- Bone marrow iron stores are a critical indicator for diagnosing iron deficiency in children.
- Bone marrow iron assessment provides valuable diagnostic information, particularly in ambiguous cases.
- Routine bone marrow aspiration is not recommended due to its invasive nature, but it remains a key diagnostic tool when needed.
Abstract:
To demonstrate the importance of bone marrow iron stores, we examined the complete hemogram, serum iron (SI), serum iron-binding capacity (SIBC), transferrin saturation (TS), serum ferritin and bone-marrow-stored iron in 31 children with iron deficiency (ID). The ages of the patients ranged from one to 14 years (mean 3.7 +/- 3.9). Laboratory findings of the 31 patients were as follows: hemoglobin (Hb) 8.5 +/- 2.4 g/dl, hematocrit (Hct) 27.8 +/- 6.3 percent, mean corpuscular volume (MCV) 58.6 +/- 8.6 fl, red blood cell count (RBC) 4 +/- 0.8 10(12)/L, red cell distribution width (RDW) 19.3 +/- 4.9, SI 17.2 +/- 9.3 microg/dl, SIBC 311 +/- 50.5 microg/dl, TS 5.5 +/- 2.8 percent and ferritin 6.7 +/- 7.3 ng/dl. In the bone marrow smears with iron stains, all patients' scores were zero for iron stores, which shows that bone-marrow-stored iron in childhood is easily affected. Because of the traumatic effect of bone marrow aspiration, it is recommended that it not be done routinely. The diagnosis of ID could be especially difficult in patients with low SI levels but normal SIBC levels and in patients with chronic inflammatory diseases. In those conditions, illustration of bone marrow stores could be of particular assistance for diagnosis of iron deficiency.