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The diagnostic criteria for iron deficiency in infants should be reevaluated
Magnus Domellöf1, Kathryn G Dewey, Bo Lönnerdal
1Department of Clinical Sciences, Pediatrics, Umeå University, Sweden. magnus.domellof@pediatri.umu.se
Insights
Diagnostic criteria for infant iron deficiency (ID) and iron deficiency anemia (IDA) need reevaluation. New cut-off values for hemoglobin and other biomarkers were established in exclusively breast-fed infants, but early prediction of IDA remains challenging.
Area of Science:
- Pediatrics
- Hematology
- Nutritional Science
Background:
- Diagnostic criteria for infant iron deficiency (ID) and iron deficiency anemia (IDA) are not well-established.
- Accurate diagnosis is crucial for timely intervention and preventing long-term health consequences.
Purpose of the Study:
- To establish appropriate cut-off values for key biomarkers in infancy.
- To evaluate the predictive utility of these biomarkers for iron status and response to supplementation.
Main Methods:
- A randomized controlled trial involving exclusively breast-fed infants in Honduras and Sweden.
- Blood samples analyzed for hemoglobin (Hb), plasma ferritin, erythrocyte mean cell volume (MCV), zinc protoporphyrin (ZPP), and soluble transferrin receptors (TfR) at 4, 6, and 9 months.
- Reference ranges determined using multiple approaches for defining iron-replete infants.
Main Results:
- Established 2 SD cut-off values for Hb, ZPP, ferritin, and TfR in iron-replete infants at different ages.
- Hemoglobin response to iron was not a reliable indicator of IDA at 4 months.
- Hb, MCV, and ZPP at 6 months, along with growth variables, predicted Hb response at 6-9 months, but ferritin and TfR did not.
Conclusions:
- Current diagnostic criteria for infant ID and IDA require reevaluation.
- Specific biomarker cut-offs have been proposed for infancy.
- Early prediction of IDA using biomarkers like ferritin and TfR at 6 months needs further investigation.
Abstract:
Diagnostic criteria for iron deficiency (ID) and iron deficiency anemia (IDA) in infants are poorly defined. Our aim was to establish appropriate cut-off values for hemoglobin (Hb), plasma ferritin, erythrocyte mean cell volume (MCV), zinc protoporphyrin (ZPP) and soluble transferrin receptors (TfR) in infancy. Exclusively breast-fed infants (n = 263) in Honduras and Sweden were randomly assigned to receive iron supplementation or placebo, and blood samples were obtained at 4, 6 and 9 mo of age. Reference ranges were determined using three different approaches for defining iron-replete infants. The usefulness of several variables for predicting the Hb response to iron was evaluated. We found the following 2 SD cut-off values in iron-replete infants: Hb <105 g/L at 4-6 mo and <100 g/L at 9 mo; ZPP >75 micro mol/mol heme at 4-6 mo and >90 micro mol/mol heme at 9 mo; ferritin <20 micro g/L at 4 mo, <9 micro g/L at 6 mo and <5 micro g/L at 9 mo; and TfR >11 mg/L at 4-9 mo. The Hb response to iron was not a useful definition of IDA at 4 mo of age. Hb, MCV and ZPP at 6 mo as well as growth variables predicted the Hb response at 6-9 mo, but ferritin and TfR at 6 mo did not. We conclude that there is need for a reevaluation of the definitions of ID and IDA in infants.