Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study.
anaemia
chemical pathology
clinical chemistry
paediatric pathology
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
05 07 2021
05 07 2021
Historique:
entrez:
6
7
2021
pubmed:
7
7
2021
medline:
5
8
2021
Statut:
epublish
Résumé
Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners. A retrospective observational study of 14 187 children aged 1-18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L. 3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia. Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.
Sections du résumé
BACKGROUND AND OBJECTIVE
Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners.
DESIGN, SETTING, PATIENTS AND MAIN OUTCOME MEASURES
A retrospective observational study of 14 187 children aged 1-18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L.
RESULTS
3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia.
CONCLUSION
Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.
Identifiants
pubmed: 34226221
pii: bmjopen-2020-046865
doi: 10.1136/bmjopen-2020-046865
pmc: PMC8258555
doi:
Substances chimiques
Ferritins
9007-73-2
Iron
E1UOL152H7
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e046865Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
JAMA. 1980 Feb 22-29;243(8):756-62
pubmed: 6986000
Clin Case Rep. 2018 Apr 17;6(6):1082-1086
pubmed: 29881569
Best Pract Res Clin Haematol. 2005 Jun;18(2):319-32
pubmed: 15737893
J Am Board Fam Med. 2014 Mar-Apr;27(2):268-74
pubmed: 24610189
Diagnosis (Berl). 2014 Jan 1;1(1):85-87
pubmed: 29539974
Best Pract Res Clin Obstet Gynaecol. 2017 Apr;40:55-67
pubmed: 28029503
BMJ. 2018 Nov 14;363:k3532
pubmed: 30429167
Acad Emerg Med. 2002 Nov;9(11):1184-204
pubmed: 12414468
Blood. 2014 Jan 30;123(5):615-24
pubmed: 24297872
Blood Rev. 2017 Jul;31(4):225-233
pubmed: 28216263
Metallomics. 2014 Apr;6(4):748-73
pubmed: 24549403
Arch Pathol Lab Med. 2020 Feb;144(2):229-239
pubmed: 31219342
EJIFCC. 2015 Jan 27;26(1):7-14
pubmed: 27683477
Stud Health Technol Inform. 2019 Aug 21;264:303-307
pubmed: 31437934
Crit Rev Oncol Hematol. 2010 Jan;73(1):1-9
pubmed: 19394859
Med Educ. 2019 Nov;53(11):1077-1086
pubmed: 31264736
Med J Aust. 2010 Nov 1;193(9):525-32
pubmed: 21034387
Paediatr Child Health. 2018 Nov;23(7):433-434
pubmed: 30374217
Turk Pediatri Ars. 2015 Mar 01;50(1):11-9
pubmed: 26078692
J Nutr. 2008 Dec;138(12):2534-6
pubmed: 19022985
Arch Intern Med. 2009 Nov 9;169(20):1881-7
pubmed: 19901140