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The use of zinc protoporphyrin in screening young children for iron deficiency
1Division of General Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229.
Insights
Zinc protoporphyrin (ZPP) screening effectively identifies iron deficiency in young children before anemia develops. This inexpensive test, when added to hematocrit (HCT) screening, improves early detection rates.
Area of Science:
- Pediatric Health
- Nutritional Science
- Biochemistry
Background:
- Current iron deficiency screening in children using hematocrit (HCT) or hemoglobin primarily detects anemia.
- Iron deficiency can exist before the development of anemia, leading to missed diagnoses.
- Early detection of iron deficiency is crucial for preventing long-term health consequences in children.
Purpose of the Study:
- To evaluate the effectiveness of zinc protoporphyrin (ZPP) screening using hematofluorimetry in young children.
- To compare the sensitivity of ZPP screening with traditional HCT screening for identifying iron deficiency.
- To assess the utility of ZPP as an early indicator of iron deficiency in pediatric populations.
Main Methods:
- A cohort of 458 children aged 9-36 months were screened for iron deficiency using blood ZPP and spun HCT.
- Children with low HCT (<33%) or elevated ZPP (≥50 µmol/mol-heme) received iron therapy (3 mg-Fe/kg/day) for 3 months.
- Response to iron therapy was assessed by changes in ZPP levels.
Main Results:
- 53% of children had normal ZPP and HCT; 34% had elevated ZPP with normal HCT.
- Children with elevated ZPP and normal HCT showed a significant therapeutic response (76% with 10% ZPP decrease, P < 0.005) to iron therapy.
- ZPP demonstrated higher sensitivity (81%) compared to HCT (16%) in detecting iron deficiency.
Conclusions:
- Zinc protoporphyrin (ZPP) screening is an effective and inexpensive method for identifying iron deficiency in young children prior to anemia onset.
- Integrating ZPP testing with HCT screening enhances the ability to detect iron deficiency earlier.
- Hematofluorimetry-based ZPP measurement offers a valuable tool for pediatric iron deficiency screening in clinical settings.
Abstract:
The common practice of screening children for iron deficiency with hematocrit (HCT) or hemoglobin detects only those children with iron deficiency severe enough to cause anemia. At 40 cents per test, zinc protoporphyrin (ZPP) can be measured in the physician's office and identify iron deficiency before anemia develops. The purpose of our study was to evaluate ZPP screening in young children by hematofluorimetry. All children between 9 and 36 months old were enrolled over a 1-year period. All children with HCT < 33% or iron deficiency (ZPP > or = 50 mumoles per mole-heme) were treated with ferrous sulfate at 3 mg-Fe/kg/day for 3 months. Four hundred and fifty-eight children were screened with a blood ZPP and spun HCT at entry. Two hundred and forty-three children (53%) had both a normal ZPP and HCT, 155 (34%) had a ZPP > or = 50 and normal HCT, 26 (6%) had a ZPP > or = 50 with HCT < 33%, and 34 (7%) had a normal ZPP and HCT < 33%. Of those with an elevated ZPP and normal HCT, 76% had a therapeutic response to iron therapy, with a 10% decrease in ZPP (P < 0.005). ZPP had a greater sensitivity (81%) than HCT (16%) in identifying children with iron deficiency. ZPP proved to be an effective and inexpensive addition to HCT in identifying children with iron deficiency.
