The utility of red blood cells distribution width in the diagnosis of iron deficiency anemia in children

Abstract

Introduction: Children's most prevalent dietary deficit is iron. Anemia affects 25% of the world's population, mostly preschoolers and women, according to the WHO. The aim is to compare red blood cell distribution width to serum ferritin, serum iron, serum total iron binding capacity, mean corpuscular volume, mean corpuscular hemoglobin concentration, and hemoglobin in diagnosing iron deficiency anemia. Method: Karbala teaching hospital for children did a prospective research. Two hundred children aged 6 months to 5 years with microcytic anemia (mean corpuscular hemoglobin < 80 fl, hemoglobin < 11 g/dl, and serum ferritin < 20 μg/ml) were assessed from January 15, 2011 to January 15, 2012. Iron-treated and blood-transfused patients were excluded. History, clinical examination, complete blood count, red blood cells distribution width, mean corpuscular hemoglobin, concentration, volume, Reticulocyte count percent, hemoglobin electrophoresis, blood film, serum ferritin, serum iron, and serum total iron binding capacity were evaluated. Children were separated into three groups based on hemoglobin levels: mild anemia (hemoglobin=10-10.9 g/dl) (30), moderate (148), and severe (22). Controls were 30 non-iron-deficient children and 30 non-anemic children (hemoglobin > 11 g/dl). Results: 130 boys (65%) and 70 girls (35%). Anemia severity reduced ferritin. The mean red blood cell distribution width in mild, moderate, and severe iron deficiency anemia was 18.5%, 19.9%, and 22%, respectively. Mean red blood cells distribution width increased with decreased mean (serum ferritin, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and mean corpuscular volume), increased with increased mean (serum iron, and serum total iron binding capacity), and was normal (<14%) in control group. Conclusion: Red blood cells distribution width is highly sensitive and specific diagnostic tool in iron deficiency anemia; especially in medical centers lacking a hematologist to read the blood smear.