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Red Blood Cell Distribution Width and the Platelet Count in Iron-deficient Children Aged 0.5-3 Years
M D Akkermans1, L Uijterschout1, J Vloemans1
1a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands.
Insights
Red blood cell distribution width (RDW) can help identify iron deficiency (ID) as a cause of anemia in young children, but it is not a primary diagnostic marker. Platelet count is not useful for diagnosing ID or iron deficiency anemia (IDA).
Area of Science:
- Pediatrics
- Hematology
- Nutritional Science
Background:
- Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is crucial for preventing neurodevelopmental impairments.
- Common biomarkers for ID are often affected by infection, limiting their diagnostic utility in this age group.
- Investigating alternative biomarkers like RDW and platelet count is necessary for accurate ID(A) diagnosis in children.
Purpose of the Study:
- To evaluate the effectiveness of red blood cell distribution width (RDW) and platelet count in detecting iron deficiency (ID) and iron deficiency anemia (IDA) in healthy young children.
- To determine if RDW and platelet count are reliable biomarkers for ID(A) in the absence of infection.
- To assess the correlation between RDW, platelet count, and serum ferritin levels in pediatric populations.
Main Methods:
- A multicenter prospective observational study involving 400 healthy children aged 0.5-3 years in the Netherlands.
- Iron deficiency (ID) defined as serum ferritin <12 μg/L without infection (C-reactive protein [CRP] <5 mg/L).
- Iron deficiency anemia (IDA) defined as hemoglobin <110 g/L plus ID. RDW and platelet count analyzed from complete blood cell counts.
Main Results:
- RDW showed an inverse correlation with serum ferritin and was not associated with CRP, indicating it's not affected by infection.
- RDW demonstrated low sensitivity and specificity for detecting ID and IDA.
- Children with anemia and RDW >14.3% had a significantly higher likelihood of having iron deficiency.
Conclusions:
- RDW can be a useful supplementary marker to identify iron deficiency as the cause of anemia in young children (0.5-3 years), but not as a standalone diagnostic tool for ID(A).
- RDW values are not influenced by concurrent infections, making them reliable in various clinical settings.
- Platelet count does not appear to have a significant role in diagnosing iron deficiency or iron deficiency anemia in this pediatric cohort.
Abstract:
Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5-3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2-6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.
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