IRON-DEFICIENCY AND ANEMIA IN CHILDREN WITH A HIGH PREVALENCE OF HEMOGLOBINOPATHIES - IMPLICATIONS FOR SCREENING

Background. Haemoglobin (Hb) concentration is used as a sole test for iron deficiency anaemia (IDA) in most developing countries since most anaemia is believed to be due to iron deficiency and confirmatory test ing is generally unavailable. Yet the validity of this approach in reg ions where haemoglobinopathies are endemic has not been documented. Me thods. Haemoglobin and serum ferritin (SF) were measured in 559 Northe rn Thai children aged 6 months to 13 years of age. The sensitivity of SF to identify iron deficiency was also assessed in a subsample of chi ldren with low or low-normal Hb and normal SF by testing the Hb respon se to a trial of oral iron. Results. While anaemia was common (27%), I DA constituted 19% and none of all anaemia in preschool and school age children, respectively (P < 0.002), Iron depletion was similarly more prevalent in younger children (P < 0.0002). Children with IDA were yo unger (P < 0.001) and the anaemia more severe (P < 0.0001) compared to those with non-IDA. Of anaemic children with normal SF values who rec eived a therapeutic trial of iron, only 6% responded with an increase in Hb of greater than or equal to 1g/dl. Conclusions. For populations such as ours most anaemia is not due to iron deficiency and a single H b determination is therefore not acceptable for a presumptive diagnosi s of IDA.