Iron deficiency screening with content hemoglobin reticulocyte (chr) in children aged 6 months to 5 years
Abstract: Anemia is a major
health problem around the world and iron deficiency is the major cause. In children
under 5 years old iron deficiency cause disruption in their growth and
development.For that reasons iron deficiency in children should be detected as
early as possible. Thegold standard for the detection of iron deficiency is
hemosiderin examination frombone marrow aspiration, but this examination is
invasive and difficult to implement.Ferritin is often used to detect iron
deficiency but it has various limitations. Reticulocyte hemoglobin content
(CHr) was introduced as a new parameter for the identification of iron
deficiency. This parameter measures the levels of hemoglobin in the
reticulocytes which is newly released from bone marrow and expected to reflect
the actual conditions in the bone marrow, therefore it can detect early iron
deficiency. It is expected that CHr can identify iron deficiency with cheaper,
easy, and applicative method. The aim of this study was to determine the
diagnostic performance of CHr in screening of iron deficiency in children aged
6 months to 5 years old. The present study was a cross sectional study to
determine the diagnostic performance of CHr and use ferritin as gold standard.
The subjects of this study were healthy children aged 6 months-5 yearsold taken
from Posyandu in Yogyakarta district and previously had obtained the consent of
their parent/guardian. The CHr examination used a flowcytometry method by Advia120
Hematology Analyzer. The ferritin examination used an electrochemiluminescens method
with Elecsys 1010. ROC curve analysis was performed using SPSS version 17. The
sensitivity, specificity, positive predictive value, negative predictive value,
accuracy, and likelihood ratio were calculated using a 2x2 TABLE. Youden’s
index was used to choose the proper cutoff level of CHr for diagnosing iron
deficiency. The study was conducted on 104 subjects. Cutoff level of CHr was
≤27.65 pg and the sensitivity, specificity, diagnostic accuracy, positive, and
negative predictive values were 91.7%,78.3%, 79.8%, 35.4%, 98.63% respectively.
Positive and negative resultsof likelihood ratios were 4.21 and 0.1. CHr is
expected to be used to screen iron deficiencyin children under 5 years old.
Author: Dea Noviana Pramantik,
Tri Ratnaningsih, Budi Mulyono
Journal Code: jpkedokterangg150362
