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Updated: Nov 20, 2025
High Content Screening Analysis to Evaluate the Toxicological Effects of Harmful and Potentially Harmful Constituents HPHC
Published on: May 10, 2016
Screening for hemophagocytic lymphohistiocytosis in child abuse evaluations: Twelve years of data
Joy M Morgan1, Angela Bachim2, Andrea T Cruz3
1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
Insights
Ferritin testing in children suspected of abuse did not identify hemophagocytic lymphohistiocytosis (HLH). Elevated ferritin levels in these cases did not rule out physical abuse diagnoses, suggesting it is not a beneficial screening tool.
Area of Science:
- Pediatric Medicine
- Forensic Pathology
- Clinical Laboratory Science
Background:
- Laboratory evaluations are crucial in diagnosing suspected child physical abuse.
- Screening panels aim to detect occult injuries and conditions mimicking abuse, such as hemophagocytic lymphohistiocytosis (HLH).
- The utility of ferritin as a screening marker for HLH in this context requires evaluation.
Purpose of the Study:
- To assess the effectiveness of hyperferritinemia as a screening marker for HLH in children undergoing evaluation for physical abuse.
Main Methods:
- A 12-year retrospective analysis (2003-2015) of ferritin levels from children evaluated for physical abuse.
- Inclusion criteria: ferritin levels > 500 ng/mL.
- Data abstraction from medical records for clinical details and diagnoses.
Main Results:
- 2954 ferritin levels were analyzed from 3091 encounters.
- Elevated ferritin (>500 ng/mL) was observed in 2.8% of cases.
- No cases of HLH were identified; the child abuse team's final impression was physical abuse in 68.8% of consulted cases.
Conclusions:
- Ferritin screening did not identify HLH in children evaluated for physical abuse.
- The inclusion of ferritin in screening panels was not found to be beneficial.
- Hyperferritinemia should not impede physical abuse diagnoses when clinical suspicion is high.
Background:
Laboratory evaluation is commonly integrated into evaluation of children with suspected physical abuse to identify occult injury and potential mimics of abuse, including hemophagocytic lymphohistiocytosis (HLH). We evaluated the utility of ferritin in laboratory screening panels for physical abuse.
Objective(S):
To determine if hyperferritinemia is a useful screening marker of HLH in physical abuse diagnostic evaluations.
Participants And Setting:
Children being evaluated for physical abuse at a quaternary pediatric referral and level one trauma center in Houston, Texas.
Methods:
We conducted a 12-year (2003 - 2015) retrospective descriptive analysis of all ferritin values obtained as part of routine screening panels for physical child abuse. Medical records were abstracted for patients with ferritin > 500 ng/mL.
Results:
2954 ferritin levels were obtained in 3091 encounters for suspected physical abuse (median age 6.5 months, interquartile range 2.3-23.5 months). Elevated ferritin was found in 82/2954 (2.8 %); no child evaluated for physical abuse was found to have HLH (95 % CI: 0-4.5%). The child abuse team was consulted in 48/82 (58.5 %) of cases, with the final impression being physical abuse in 33/48 (68.8 %).
Conclusions:
We found no instances where HLH was identified by institutional screening panels. The inclusion of ferritin in the screening panel was not beneficial. The presence of hyperferritinemia should not cast medical or legal doubt on physical abuse diagnoses when there is a high index of clinical suspicion. Novel hypotheses from case reports and case series should be studied more rigorously before affecting system change.
