Detection of iron deficiency in children with Down syndrome

Sarah J Hart, Kanecia Zimmerman, Corinne M Linardic, Sheila Cannon, Anna Pastore, Vasiliki Patsiogiannis, Paolo Rossi, Stephanie L Santoro, Brian G Skotko, Amy Torres, Diletta Valentini, Kishore Vellody, Gordon Worley, Priya S Kishnani

Research output: Contribution to journalArticle

Abstract

PURPOSE: Current American Academy of Pediatrics guidelines for children with Down syndrome (DS) recommend a complete blood count (CBC) at birth and hemoglobin annually to screen for iron deficiency (ID) and ID anemia (IDA) in low-risk children. We aimed to determine if macrocytosis masks the diagnosis of ID/IDA and to evaluate the utility of biochemical and red blood cell indices for detecting ID/IDA in DS.

METHODS: We reviewed data from 856 individuals from five DS specialty clinics. Data included hemoglobin, mean corpuscular volume, red cell distribution width (RDW), percent transferrin saturation (TS), ferritin, and c-reactive protein. Receiver operating characteristic curves were calculated.

RESULTS: Macrocytosis was found in 32% of the sample. If hemoglobin alone was used for screening, all individuals with IDA would have been identified, but ID would have been missed in all subjects. RDW had the highest discriminability of any single test for ID/IDA. The combination of RDW with ferritin or TS led to 100% sensitivity, and RDW combined with ferritin showed the highest discriminability for ID/IDA.

CONCLUSION: We provide evidence to support that a CBC and ferritin be obtained routinely for children over 1 year old with DS rather than hemoglobin alone for detection of ID.

Original languageEnglish
JournalGenetics in Medicine
DOIs
Publication statusE-pub ahead of print - Aug 16 2019

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Erythrocyte Indices
Down Syndrome
Iron-Deficiency Anemias
Iron
Ferritins
Hemoglobins
Blood Cell Count
Transferrin
Masks
ROC Curve
Anemia
Erythrocytes
Parturition
Guidelines
Pediatrics
Proteins

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Hart, S. J., Zimmerman, K., Linardic, C. M., Cannon, S., Pastore, A., Patsiogiannis, V., ... Kishnani, P. S. (2019). Detection of iron deficiency in children with Down syndrome. Genetics in Medicine. https://doi.org/10.1038/s41436-019-0637-4

Detection of iron deficiency in children with Down syndrome. / Hart, Sarah J; Zimmerman, Kanecia; Linardic, Corinne M; Cannon, Sheila; Pastore, Anna; Patsiogiannis, Vasiliki; Rossi, Paolo; Santoro, Stephanie L; Skotko, Brian G; Torres, Amy; Valentini, Diletta; Vellody, Kishore; Worley, Gordon; Kishnani, Priya S.

In: Genetics in Medicine, 16.08.2019.

Research output: Contribution to journalArticle

Hart, SJ, Zimmerman, K, Linardic, CM, Cannon, S, Pastore, A, Patsiogiannis, V, Rossi, P, Santoro, SL, Skotko, BG, Torres, A, Valentini, D, Vellody, K, Worley, G & Kishnani, PS 2019, 'Detection of iron deficiency in children with Down syndrome', Genetics in Medicine. https://doi.org/10.1038/s41436-019-0637-4
Hart, Sarah J ; Zimmerman, Kanecia ; Linardic, Corinne M ; Cannon, Sheila ; Pastore, Anna ; Patsiogiannis, Vasiliki ; Rossi, Paolo ; Santoro, Stephanie L ; Skotko, Brian G ; Torres, Amy ; Valentini, Diletta ; Vellody, Kishore ; Worley, Gordon ; Kishnani, Priya S. / Detection of iron deficiency in children with Down syndrome. In: Genetics in Medicine. 2019.
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abstract = "PURPOSE: Current American Academy of Pediatrics guidelines for children with Down syndrome (DS) recommend a complete blood count (CBC) at birth and hemoglobin annually to screen for iron deficiency (ID) and ID anemia (IDA) in low-risk children. We aimed to determine if macrocytosis masks the diagnosis of ID/IDA and to evaluate the utility of biochemical and red blood cell indices for detecting ID/IDA in DS.METHODS: We reviewed data from 856 individuals from five DS specialty clinics. Data included hemoglobin, mean corpuscular volume, red cell distribution width (RDW), percent transferrin saturation (TS), ferritin, and c-reactive protein. Receiver operating characteristic curves were calculated.RESULTS: Macrocytosis was found in 32{\%} of the sample. If hemoglobin alone was used for screening, all individuals with IDA would have been identified, but ID would have been missed in all subjects. RDW had the highest discriminability of any single test for ID/IDA. The combination of RDW with ferritin or TS led to 100{\%} sensitivity, and RDW combined with ferritin showed the highest discriminability for ID/IDA.CONCLUSION: We provide evidence to support that a CBC and ferritin be obtained routinely for children over 1 year old with DS rather than hemoglobin alone for detection of ID.",
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AU - Hart, Sarah J

AU - Zimmerman, Kanecia

AU - Linardic, Corinne M

AU - Cannon, Sheila

AU - Pastore, Anna

AU - Patsiogiannis, Vasiliki

AU - Rossi, Paolo

AU - Santoro, Stephanie L

AU - Skotko, Brian G

AU - Torres, Amy

AU - Valentini, Diletta

AU - Vellody, Kishore

AU - Worley, Gordon

AU - Kishnani, Priya S

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N2 - PURPOSE: Current American Academy of Pediatrics guidelines for children with Down syndrome (DS) recommend a complete blood count (CBC) at birth and hemoglobin annually to screen for iron deficiency (ID) and ID anemia (IDA) in low-risk children. We aimed to determine if macrocytosis masks the diagnosis of ID/IDA and to evaluate the utility of biochemical and red blood cell indices for detecting ID/IDA in DS.METHODS: We reviewed data from 856 individuals from five DS specialty clinics. Data included hemoglobin, mean corpuscular volume, red cell distribution width (RDW), percent transferrin saturation (TS), ferritin, and c-reactive protein. Receiver operating characteristic curves were calculated.RESULTS: Macrocytosis was found in 32% of the sample. If hemoglobin alone was used for screening, all individuals with IDA would have been identified, but ID would have been missed in all subjects. RDW had the highest discriminability of any single test for ID/IDA. The combination of RDW with ferritin or TS led to 100% sensitivity, and RDW combined with ferritin showed the highest discriminability for ID/IDA.CONCLUSION: We provide evidence to support that a CBC and ferritin be obtained routinely for children over 1 year old with DS rather than hemoglobin alone for detection of ID.

AB - PURPOSE: Current American Academy of Pediatrics guidelines for children with Down syndrome (DS) recommend a complete blood count (CBC) at birth and hemoglobin annually to screen for iron deficiency (ID) and ID anemia (IDA) in low-risk children. We aimed to determine if macrocytosis masks the diagnosis of ID/IDA and to evaluate the utility of biochemical and red blood cell indices for detecting ID/IDA in DS.METHODS: We reviewed data from 856 individuals from five DS specialty clinics. Data included hemoglobin, mean corpuscular volume, red cell distribution width (RDW), percent transferrin saturation (TS), ferritin, and c-reactive protein. Receiver operating characteristic curves were calculated.RESULTS: Macrocytosis was found in 32% of the sample. If hemoglobin alone was used for screening, all individuals with IDA would have been identified, but ID would have been missed in all subjects. RDW had the highest discriminability of any single test for ID/IDA. The combination of RDW with ferritin or TS led to 100% sensitivity, and RDW combined with ferritin showed the highest discriminability for ID/IDA.CONCLUSION: We provide evidence to support that a CBC and ferritin be obtained routinely for children over 1 year old with DS rather than hemoglobin alone for detection of ID.

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