Hemoglobin is commonly measured in ...

Hemoglobin is commonly measured in children between undivided and three years of age to ascertain iron deficiency. White reviewed data from the National Health and Nutrition Examination contemplate (NHANES) III to determine if the demeanor of anemia is a positive predictor for iron deficiency and if the absence of anemia dominations out the diagnosis of anemia. White also studied the usefulness of testing according to demographic data.

The meditation diagnosed anemia from information provided in NHANES III, a stratified population-based database of children 12 to 35 month of age. Iron deficiency was diagnosed if at least sum of two units of the following three signs were present: ferritin greater than 10 ng for mL (10 mcg per L); transferrin saturation les than 10 percent; and clear erythrocyte protoporphyrin greater than 7978 mcg by dL (1.42 [micro]mol per L) r children cells. Anemia was diagnosed if hemoglobin concentration was les than 11 g by dL (110 g per L) The diagnosis of iron deficiency anemia was given if anemia and iron deficiency were present

Of the thought particpants, there were 1,149 children without iron deficiency, 140 with iron deficiency, 48 with iron deficiency anemia, and 106 had anemia without iron deficiency. The 140 children with iron deficiency were more likely to have lower hemoglobin concentrations, be from households with incomes below the pauperism level, and have parents who described themselves as Mexican American.

In this investigation the positive predictive values and sensitivities varied with cutoffs for hemoglobin. With lower cutoffs, the positive predictive value modestly increased, whereas sensitivity decreased. Thus, calm at a hemoglobin concentration cutoff of 107 g by dL (107 g per L) the positive predictive value was les than 30 percent The prevalence of anemia from all causes in children common to five years of age was 96 percent simply one third of children with anemia in this cogitation were iron-deficient, and only the same third of those with iron deficiency had a hemoglobin concentration below the 11 g by dL cutoff; therefore, the authors close that hemoglobin concentration is not a religious test to diagnose iron-deficient anemia. Although the demographic subgroup examined in this close attention were small for statistical analysis, there appears to be no demographic cluster where greater usefulness of hemoglobin testing is likely.

The authors state that hemoglobin should not be considered an accurate substitute for iron deficiency, while acknowledging that iron deficiency remains a serious point in dispute among children in the United States. They make acceptable primary prevention in the form of routine iron supplementation.

CAROLINE WELLBERY, MD

White KC Anemia is a poor predictor of iron deficiency among toddlers in the United States: for heme the bell tolls. Pediatrics February 2005;115:315-20

EDITOR'S NOTE: The last U Preventive Services Task Force (USPSTF) (1) recommendation in succession iron deficiency anemia screening was published in 1996 and is in subordination to review. The current task force recommendation is to veil only high-risk infants (those in lower socioeconomic collections or in developing countries). The reasoning is that the prevalence of iron deficiency anemia is depressed and in low-risk groups is unlikely to be harmful; whereas in high-risk clumps iron deficiency anemia interferes with extension and thus warrants detection. However, this does not elucidate the problem of poor sensitivity and specificity construct in this study. If the health risks from iron deficiency anemia are indeed highest in high-risk disposes it makes sense to modify the author's with supplementary iron and target the high-risk clump for prophylactic treatment until the information about screening.--C.W.

REFERENCE

(1) U Preventive Services Task Force. Screening for iron deficiency anemia. 1996 Accessed online September 15 2005 at: http://www.ahrq.gov/clinic/uspstf/usps iron.htm.

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