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Published on: January 19, 2024
Screening for Iron Deficiency Anemia in Infants in a Thalassemia-endemic Region
Natthawadee Nanta1, Rungrote Natesirinilkul1, Kulnipa Kittisakmontri1
1Department of Pediatrics, Faculty of Medicine, Chiang Mai University.
Insights
Screening infants for iron deficiency anemia (IDA) and thalassemia carriers requires careful evaluation. The Mentzer index, alongside hemoglobin levels, effectively aids in distinguishing these conditions in endemic areas.
Area of Science:
- Pediatric Hematology
- Nutritional Anemias
- Genetic Blood Disorders
Background:
- Iron deficiency anemia (IDA) screening in infants typically relies on hemoglobin (Hb) and mean corpuscular volume (MCV).
- Co inherited thalassemia carrier status can complicate IDA diagnosis in infants.
- Thalassemia is prevalent in many regions, necessitating accurate diagnostic approaches.
Purpose of the Study:
- To differentiate hematologic parameters in infants with IDA versus thalassemia carriers.
- To evaluate the utility of red blood cell indices for IDA screening in a thalassemia-endemic setting.
- To identify reliable markers for simultaneous screening of IDA and thalassemia carriers in infants.
Main Methods:
- Enrollment of healthy infants aged 6-12 months for hematologic analysis.
- Collection of blood for complete blood count, ferritin, Hb analysis, and alpha-thalassemia genotyping.
- Calculation and analysis of red cell parameters, including the Mentzer index, to distinguish thalassemia carriers.
Main Results:
- Of 85 infants, 18.8% had IDA and 29.4% were thalassemia carriers.
- Both IDA and thalassemia carrier groups exhibited significantly lower Hb levels and MCV compared to controls.
- The Mentzer index demonstrated high diagnostic performance (AUC 0.867) for identifying thalassemia carriers.
Conclusions:
- Hemoglobin level and Mentzer index are valuable tools for screening IDA in infants.
- Combined screening using Hb and Mentzer index can effectively identify both IDA and thalassemia carriers.
- These parameters are recommended for population-based screening in thalassemia-endemic areas.
Abstract:
Screening for iron deficiency anemia (IDA) in infants is usually carried out by hemoglobin (Hb) level and mean corpuscular volume (MCV). A coinherited thalassemia carrier may confound the diagnosis of IDA. This study aimed to characterize the hematologic parameters in infants with IDA and in thalassemia carriers, and to study the use of red cell parameters in IDA screening in a thalassemia-endemic area. Healthy infants, 6 to 12 months of age were enrolled. Blood samples were taken for complete blood count, ferritin level, Hb analysis, and polymerase chain reaction for alpha-thalassemia. IDA was defined as Hb <11.0 g/dL and ferritin <12 μg/L. Formulae calculated from red cell parameters to distinguish thalassemia carriers were analyzed. Eighty-five infants, 8.3±2.4 months of age, including 48 (56.5%) male infants were enrolled. Sixteen infants (18.8%) had IDA. There were 25 thalassemia carriers (29.4%), 1 Hb H disease, and 1 homozygous Hb E. Hb levels and MCV in the IDA and thalassemia carrier groups were significantly lower than those in the normal group. Area under the curve of Mentzer index (MCV/red blood cell count <13) to suggest thalassemia carriers was 0.867 (95% confidence interval: 0.784-0.951), and the sensitivity and specificity were 92.6% and 72.4%, respectively. In conclusion, both Hb level and Mentzer index are recommended for screening of IDA and thalassemia carriers in the population.
