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Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
Iron Deficiency in Anemic Children Surviving Critical Illness: Post Hoc Analysis of a Single-Center Prospective
Geneviève Du Pont-Thibodeau1, Shu Yin Han Li1, Laurence Ducharme-Crevier1
1Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
Insights
Post-PICU anemia is common in children, often linked to iron depletion and inflammation. Hepcidin shows promise for diagnosing iron deficiency in these complex cases.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Nutritional Science
Background:
- Anemia is a frequent complication for children discharged from the Pediatric Intensive Care Unit (PICU).
- The underlying causes of post-PICU anemia, including iron depletion and inflammation, are not well understood.
- Anemia treatments beyond blood transfusions are seldom initiated during PICU stays.
Purpose of the Study:
- To investigate the roles of iron depletion (ID) and inflammation in the development of anemia after PICU discharge.
- To evaluate the effectiveness of hepcidin, a novel iron biomarker, in identifying ID in pediatric patients experiencing inflammation.
- To characterize the prevalence and types of anemia and iron status in children post-PICU.
Main Methods:
- A post hoc analysis was conducted on data from a single-center prospective study spanning November 2019 to September 2022.
- The study included children admitted to the PICU requiring prolonged ventilation (≥48 hours invasive or ≥96 hours noninvasive), excluding those with pre-existing anemia causes or post-cardiac surgery admissions.
- Hematological and iron profiles were assessed at PICU discharge and at a 2-month follow-up for anemic patients.
Main Results:
- Of 56 participants, 37 (66%) had anemia at PICU discharge, with 59% being under 2 years old.
- At discharge, 15% had anemia of inflammation (AI), 6% had iron deficiency anemia (IDA), and 11 additional patients developed ID post-PICU.
- An exploratory analysis suggested a hepcidin cutoff of 31.9 pg/mL could improve ID detection during inflammation from 6% to 34%.
Conclusions:
- Iron depletion is a significant issue for children following PICU stays, necessitating improved management strategies.
- Hepcidin holds potential for enhancing the diagnosis of iron deficiency in pediatric patients with concurrent inflammation.
- Further research is warranted to optimize the treatment of post-PICU anemia and iron deficiency.
Objectives:
Many children leave the PICU with anemia. The mechanisms of post-PICU anemia are poorly investigated, and treatment of anemia, other than blood, is rarely started during PICU. We aimed to characterize the contributions of iron depletion (ID) and/or inflammation in the development of post-PICU anemia and to explore the utility of hepcidin (a novel iron marker) at detecting ID during inflammation.
Design:
Post hoc analysis of a single-center prospective study (November 2019 to September 2022).
Setting:
PICU, quaternary center, Canada.
Patients:
Children admitted to PICU with greater than or equal to 48 hours of invasive or greater than or equal to 96 hours of noninvasive ventilation. We excluded patients with preexisting conditions causing anemia or those admitted after cardiac surgery.
Interventions:
None.
Measurements And Main Results:
Hematological and iron profiles were performed at PICU discharge on 56 participants of which 37 (37/56) were diagnosed with anemia. Thirty-three children (33/56; 59%) were younger than 2 years. Median Pediatric Logistic Organ Dysfunction score was 11 (interquartile range, 6-16). Twenty-four of the 37 anemic patients had repeat bloodwork 2 months post-PICU. Of those, four (4/24; 16%) remained anemic. Hematologic profiles were categorized as: anemia of inflammation (AI), iron deficiency anemia (IDA), IDA with inflammation, and ID (low iron stores without anemia). Seven (7/47; 15%) had AI at discharge, and one had persistent AI post-PICU. Three patients (3/47; 6%) had IDA at discharge; of which one was lost to follow-up and the other two were no longer anemic but had ID post-PICU. Eleven additional patients developed ID post-PICU. In the exploratory analysis, we identified a diagnostic cutoff value for ID during inflammation from the receiver operating characteristic curve for hepcidin of 31.9 pg/mL. This cutoff would increase the detection of ID at discharge from 6% to 34%.
Conclusions:
The burden of ID in children post-PICU is high and better management strategies are required. Hepcidin may increase the diagnostic yield of ID in patients with inflammation.
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