Serum ferritin for pediatric iron screening: promise for primary care

  • Pediatrics

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For iron deficiency screening in very young children, serum ferritin measures at 15 or 18 months can be useful in primary care.
  • Adding C-reactive protein (CRP) measurement in children at low acute inflammation risk may not be needed.

Why this matters

  • The current American Academy of Pediatrics recommendation is to screen for anemia at age 12 months, using hemoglobin.
  • Sensitivity and specificity of hemoglobin for iron deficiency are low, and optimal screening age is unclear.
  • Editorial entitled “ Looking behind the iron curtain ” asks, “are we ready to replace the hemoglobin test?” and answers: “Not yet.”

Key results

  • Serum ferritin values stayed low and changed very little from ages 15 to 24 months.
  • They increased by an average 2% for each month from 24 to 38 months; by contrast, hemoglobin increased by 20%. 
  • When comparing hemoglobin , hemoglobin sensitivity was 25% (95% CI, 19%-32%) and specificity was 89% (95% CI, 87%-91%).
  • Only 3.3% had CRP ≥10 mg/L.

Study design

  • Cross-sectional, children ages 1-3 years (1735 for ferritin analysis).
  • Funding: Canadian Institutes of Health Research.

Limitations

  • No information on other causes of anemia.

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