西宁市3—12岁儿童Hb—SFEP测定值的相关分析

本文通过要市４２６名３￣１２岁儿童Ｈｂ及ＦＥＰ二项值的测定，发现用全国建议的西它折算标准来判断本组儿童的贫血患病率为５１．７０％，其中非缺铁性贫血竞高达４４．４％。因此，建议为解决我国不同海拔高度地区血红蛋白低限值的标准制定，必须对所测样本作出严格的统一要求。     

儿童铁缺乏和缺铁性贫血防治专家共识

铁缺乏症（iron deficiency,ID）、缺铁性贫血（iron deficiency anemia,IDA）影响儿童生长发育及大脑认知功能发展。我国儿童ID和IDA患病率较早年已明显下降，但由于国土辽阔、各区域的发展程度不均以及各民族生活习惯差异等原因，部分区域儿童的患病率仍然较高。儿童ID和IDA的规范化防治对改善儿童生长发育，提高我国人口素质意义重大。为此，中华预防医学会儿童保健分会、中国妇幼保健协会儿童早期发展专业委员会、福棠儿童医学发展研究中心儿童保健专业委员会和《中国实用儿科杂志》编辑委员会组织专家参考国家相关部门文件及国内外临床指南共识，查阅循证文献，通过反复研讨形成符合我国临床需求的《儿童铁缺乏和缺铁性贫血防治专家共识》。     

单个网织红细胞血红蛋白量在诊断儿童缺铁性贫血中的意义

目的研究网织红细胞血红蛋白量(CHr)在诊断儿童缺铁性贫血(IDA)中的意义。方法 100例1～6岁IDA患儿和50例正常儿童(对照组)作为研究对象。采用血细胞分析仪检测CHr、Hb、RBC、平均红细胞容积(MCV)等红细胞参数;采用放射免疫双抗体法检测血清铁蛋白(SF);采用ELISA方法测定转铁蛋白受体(sTfR)。结果 IDA组的Hb和CHr分别为100±6 g/L和18±5 pg,低于对照组(126±8 g/L,31±3 pg;P<0.01)。IDA组的SF(11±4μg/L)低于对照组(59±36μg/L;P<0.01);sTfR则高于对照组(4.8±2.1 mg/L vs1.4±0.6 mg/L;P<0.01)。对照组、IDA组的CHr与Hb呈正相关(r分别为0.540,0.734,P<0.01);IDA组的CHr与SF呈正相关(r=0.464,P<0.01);IDA组的CHr与sTfR呈负相关(r=-0.450,P<0.01)。当CHr的临界值为27.8 pg时,诊断小儿IDA的敏感度和特异度分别为88.0%和90.0%,ROC曲线下面积为0.948。结论 CHr可以作为诊断儿童IDA的指标。     

缺铁性贫血对儿童体格发育影响的研究

在云南大理地区采用血红蛋白（Ｈｂ）和红细胞内游离原卟啉（ＦＥＰ）指标进行０￣１４岁儿童铁缺乏症普查，同时测量身高、体重。在缺铁性贫血（ＩＤＡ）组和正常组选择家庭经济状况相似的儿童按各年龄组及性别２：１配对。ＩＤＡ组１５６６例，男７８６例、女７８０例；正常组７８３名，男３９３名、女３９０名。并且在ＩＤＡ组和正常组分别抽样４０例、３３名儿童测定转铁蛋白（ＴＲＦ）和前白蛋白（ＰＡ）。结果ＩＤＡ患儿ＰＡ和     

缺铁性贫血儿童血清铁,锌,铜,锰和钙含量的变化及临床意义

本文观察了105例缺铁性贫血(IDA)儿童的血清铁、锌、铜、锰、钙含量变化,同时分析其饮食特点和临床表现。资料及方法按IDA 的诊断标准,诊断105例IDA,研究对象均来自营养专科门诊,年龄8～14岁,观察贫血儿童(贫血组)血清铁、锌、铜、锰及钙含量变化,并与85例非贫血儿童(正常组)进行比较,对IDA     

儿童幽门螺杆菌感染与缺铁性贫血的关系

目的探讨儿童幽门螺杆菌（Hp）感染与缺铁性贫血（IDA）之间的关系。方法对90例有消化道症状的患儿进行胃镜检查和Hp检测,根据检查结果分为Hp阳性观察组和Hp阴性对照组。病例均检测血常规、血清铁（SI）、血清铁蛋白（SF）、总铁结合力（TIBC）等IDA指标。结果观察组44例中IDA23例,IDA发病率为52.27%;对照组46例中IDA8例,IDA发病率为17.39%;二者比较差异有统计学意义（χ^2=12.12P〈0.05）。结论儿童Hp感染与缺铁性贫血有关,Hp感染可能为IDA的发病因素之一。     

生理性铁缺乏的假说及其潜在意义

目的 本文提出了少儿生长期存在生理性铁缺乏的新假说,并以实验学方法予以验证。方法 在阐述概念和理论依据基础上,以大鼠进行了实验验证并对营养性铁缺乏和生理性贫血作出了界定。结果 实验结果支持大鼠生长期存在生理性铁缺乏状态;此时给予富铁干预,对成年期铁代谢将产生不利的影响;贫铁干预则可产生回忆性激活效果。结论 作者认为,尽管大鼠铁代谢与人类毕竟不竟相同,但人类生长期是否存在生理性铁缺乏时段以及临床应如何对待,均值得进一步研究。     

重症小儿缺铁性贫血治疗中红细胞悬液应用的临床分析

目的 分析重症缺铁性贫血患儿输注红细胞悬液或全血的临床疗效。方法 采用卫生统计学中的两样本比较t检验以及X2检验比较观察组、对照组中各20例患儿应用红细胞悬液或全血后,临床各项指标恢复时间,治疗前Hb、SF、FEP及临床副作用发生率。结果 (1)临床指标(皮肤粘膜苍白、疲乏无力、食欲减退、心率增快、肝脾肿大、合并感染),两组比较P值<0.05,有显著差异。(2)两组输血治疗缺铁性贫血副作用发生例数比较P值<0.05,有显著差异。(3)两组缺铁性贫血患儿治疗前后各项指标的比较,治疗前后比较,P值<0.05,组间比较P值<0.05。结论对于缺铁性贫血的患儿,输注红细胞悬液,其临床症状、体征恢复时间较全血短,副作用发生率小。     

儿童缺铁性贫血对神经系统的影响及其防治进展

缺铁性贫血 (IDA)是铁缺乏症的晚期表现。铁是人体正常生理活动不可缺少的物质 ,是人体必需的微量元素 ,缺铁时触酶和细胞色素酶活力降低 ,不仅影响小儿造血系统 ,也可影响其智能发育 ,缺铁儿童即使在贫血不严重时也可有神经精神改变 :烦躁不安、对周围环境不感兴趣、注意力不集中、理解力降低、反应缓慢及学习成绩下降等。一、IDA流行病学　妇女、婴幼儿及儿童是IDA的高危人群。不同年龄组IDA患病率差异显著 ,各地报道不一 ,但以 6个月～ 3岁发病率最高。此年龄段是小儿心理和行为快速发展的时期 ,在此阶段发生IDA对儿童极易造成损害…     

Red blood cell distribution width is not a reliable biomarker for low iron stores in children with cystic fibrosis

Low iron stores in children, absolute iron deficiency (AID), can lead to impaired neurodevelopment and requires iron therapy. In the presence of infection/inflammation, like in cystic fibrosis (CF), serum ferritin (SF) is not a reliable biomarker for AID. Red blood cell distribution width (RDW) is a promising alternative reported not to be influenced by infection in healthy children. Currently, there are no data on the diagnostic capacity of RDW to detect AID in pediatric CF patients. This was a prospective observational study that investigated iron status biomarkers in 53 Dutch pediatric CF patients. AID was defined using World Health Organization criteria for SF in stable patients (no recent pulmonary exacerbation) and C-reactive protein (CRP) ≤10 mg/l. Patients with AID had higher RDW levels than patients without AID (p = 0.019). An RDW ≥13.2% showed the following test statistics: sensitivity 100%; specificity 39.4%; positive predictive value 20%; and negative predictive value 100%. Furthermore, we found a correlation between RDW and CRP in the total group that originated from the stable patients (r = 0.308; p = 0.042). In conclusion, the diagnostic capacity of RDW for detecting AID in pediatric CF patients seems limited because RDW levels might also be influenced by chronic infection/inflammation in these patients.     

汉中市儿童、孕妇铁缺乏症流行病学调查研究分析

目的 调查了解儿童、妇女铁减少（ID）、缺铁性贫血（IDA）及铁缺乏症（1DD）患病率。方法 随机抽取汉中市城区7月～7岁儿童532名，30岁以下妊娠38周以内孕妇203名，30岁以下未孕育龄妇女200名为调查对象。检测了血红蛋白（Hb）、锌原卟啉（ZPP）、血清铁蛋白（SF）等指标。结果7个月～7岁儿童ID平均43．80％，IDA平均9．96％。其中7个月～12个月婴儿ID71．67％．IDA22．50％：3个月～36个月幼儿ID33．13％，IDA8．13％；37个月～7岁儿童ID37．30％，IDA5．16％。孕妇ID平均82．17％，IDA平均37．93％。其中早孕组ID75．91％，IDA14．46％，中孕组ID77．14％，IDA51．43％；晚孕组ID100．00％，IDA58．00％。未孕育龄妇女ID49．50％．IDA25．00％。儿童ID、IDA不同年龄组有显著差异（P〈0．01），即年龄越小、患病率越高。孕妇孕龄组之间有显著性差异（P〈0．01）。即孕龄越大，患病率越高。孕妇ID、IDA患病率与育龄妇女有显著性差异（P〈0．01）。孕妇患病率明显高于育龄妇女。不同年龄组儿童、不同孕期孕妇及育龄妇女ID患病率均大于IDA患病率。结论本市儿童、孕妇、育龄妇女铁缺乏症比较普遍，ID、IDA患病率均高于国外和全国平均水平。隐性缺铁十分严重，已成为营养性铁缺乏症的主要问题。婴幼儿和晚期孕妇是铁缺乏症高发人群。     

汉中市儿童、孕妇铁缺乏症流行病学调查研究分析

目的调查了解儿童、妇女铁减少(ID)、缺铁性贫血(IDA)及铁缺乏症(IDD)患病率。方法随机抽取汉中市城区7月～7岁儿童532名,30岁以下妊娠38周以内孕妇203名,30岁以下未孕育龄妇女200名为调查对象。检测了血红蛋白(Hb)、锌原卟啉(ZPP)、血清铁蛋白(SF)等指标。结果7个月～7岁儿童ID平均43.80%,IDA平均9.96%。其中7个月～12个月婴儿ID71.67%,IDA22.50%;3个月～36个月幼儿ID33.13%,IDA8.13%;37个月～7岁儿童ID37.30%,IDA5.16%。孕妇ID平均82.17%,IDA平均37.93%。其中早孕组ID75.91%,IDA14.46%,中孕组ID77.14%,IDA51.43%;晚孕组ID100.00%,IDA58.00%。未孕育龄妇女ID49.50%,IDA25.00%。儿童ID、IDA不同年龄组有显著差异(P<0.01),即年龄越小、患病率越高。孕妇孕龄组之间有显著性差异(P<0.01)。即孕龄越大,患病率越高。孕妇ID、IDA患病率与育龄妇女有显著性差异(P<0.01)。孕妇患病率明显高于育龄妇女。不同年龄组儿童、不同孕期孕妇及育龄妇女ID患病率均大于IDA患病率。结论本市儿童、孕妇、育龄妇女铁缺乏症比较普遍,ID、IDA患病率均高于国外和全国平均水平。隐性缺铁十分严重,已成为营养性铁缺乏症的主要问题。婴幼儿和晚期孕妇是铁缺乏症高发人群。     

Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia

Objective  To study the utility of red cell distribution width (RDW) in the diagnosis of iron deficiency among children with microcytic hypochromic anemia. Methods  151 children (6 months-12 years) with microcytic (MCV<75 fl) anemia were classified into iron deficient (IDA) and non-iron deficient anemia (non-IDA) on the basis of serum ferritin and total iron binding capacity (TIBC). RDW values were obtained on an automated hematology analyzer. Receiver operator curves (ROC) were constructed and the utility of RDW in diagnosis of iron deficiency was studied. Results  The mean RDW value was 18.37±2.22% in IDA group (97 children) compared to 16.55±1.51 % in the non-IDA group (54 children) (p<0.0001, unpaired t test). In IDA group, the mean RDW value was 16.60±1.78%, 17.95±1.91% and 20.55±1.32% among mild, moderate and severely anemic children (p<0.0001, ANOVA test). The corresponding values in non-IDA group were 16.03±1.25%, 16.76±1.20% and 16.77±2.68% respectively (p=0.269, ANOVA test). At a cut-off value of 17.4%, as obtained from the ROC curve, the sensitivity and specificity of RDW in diagnosis of IDA were 81.0% and 53.4% and a positive and negative predictive value of 63.0% and 72.2% respectively. Conclusion  RDW has a limited specificity for diagnosis of IDA among children with microcytic hypochromic anemia.     

Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia

BACKGROUND: Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common forms of microcytic anemia. Some discrimination indices calculated from red blood cell indices are defined and used for rapid discrimination between TT and IDA. However, there has been no study carried out in which the validity of all of the defined indices are compared in the same patient groups. Youden's index is the most reliable method by which to measure the validity of a particular technique, because it takes into account both sensitivity and specificity. METHODS: We calculated eight discrimination indices (Mentzer Index, England and Fraser Index, Srivastava Index, Green and King Index, Shine and Lal Index, red blood cell (RBC) count, red blood cell distribution width and red blood cell blood distribution width index (RDWI)) in 26 patients with IDA and in 37 patients with beta TT (betaTT). We determined the number of correctly identified patients by using each discrimination index. We also calculated sensitivity, specificity, positive and negative predictive value and Youden's index of each discrimination index. RESULTS: None of the discrimination indices showed a sensitivity and specificity of 100%. Youden's indices of RBC count and RDWI were the highest with the value of 82 and 80%, respectively. Ninety percent and 92% of the patients were correctly identified with RBC and RDWI, respectively. CONCLUSIONS: Red blood cell count and RDWI are the most reliable discrimination indices in differentiation between betaTT and IDA.     

Cord blood zinc protoporphyrin/heme ratio in minority neonates at risk for iron deficiency

We measured cord blood zinc protoporphyrin/heme (ZnPP/H) and plasma ferritin in healthy African-American and Hispanic newborns, matched by gestation with Caucasian newborns. In these at-risk minorities, cord ZnPP/H was higher and plasma ferritin lower, supporting the feasibility of screening newborns at-risk for iron deficiency at birth.     

Red blood cell indices and iron status according to feeding practices in infants and young children

With the electronic counters routinely used, it has become practical to determine the concentration of hemoglobin, red cell indices, and RDW concurrently in association with transferrin saturation and ferritin in accordance with feeding practices. The 1028 infants and children aged 6 to 24 months, who had been mainly admitted with acute infectious or inflammatory diseases, were divided into three groups, i.e., children who were exclusively breast-fed more than 6 months (group A), those who had been given iron-fortified formula milk since birth (group B), and those who had been given breast milk for 5–6 months and then switched to the iron-fortified formula (group C). Children with anemia comprised 34.8% (104/299) of group A, significantly more than 5.6% (34/608) of group B and 6.6% (8,/121) of group C ( p < 0.001, respectively). Children with MCV < 70 fl comprised 39.5% (118/299) of group A, significantly more than 7.1% (43/608) of group B and 13.2% (16/121) of group C. Out of the total 146 patients with anemia, 82.2% ( n = 120) had laboratory evidence of iron deficiency, which was mostly suggested by a dietery history. The sensitivity of MCV values < 70 fl in IDA patients was 90.0%; specificity was 53.8%. The sensitivity of RDW values ≥ 15% was 83.3%; specificity was 57.7%. The positive predictive value could be increased to 97.8% by combining MCV < 70 fl and RDW ≥ 15%. The sensitivity of serum ferritin concentrations < 10ng/ml was 62.4% and specificity was 100%. The sensitivity of transferrin saturation < 12% was 72.3% and specificity was 81.3%. By combining the hemoglobin with MCV and RDW in screening for iron deficiency, the diagnostic accuracy of IDA can be increased. We support the use of appropriately iron-fortified weaning foods or the routine iron supplement starting at 6 months of age in exclusively breast-fed infants.     

Intravenous iron sucrose for children with iron deficiency failing to respond to oral iron therapy

Background

For decades, parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis‐dependent patients receiving erythropoietin. Newer intravenous (IV) iron formulations such as iron sucrose have replaced high‐molecular weight iron (HMW) dextran in dialysis patients; however, the use of parenteral iron in children without renal disease has not been well defined.

Procedure

Pharmacy records were reviewed on children (≤18 years of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis.

Results

Thirty‐eight children received iron sucrose for non‐renal indications, 13 with iron deficiency refractory to oral iron therapy, 13 with iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. Among these 38 children, who received a total of 510 doses of IV iron sucrose, there were only six adverse reactions. Patients in all categories had a good response to the iron sucrose, with a median hemoglobin rise of 1.9–3.1 g/dl depending on the indication.

Conclusions

Parenteral iron is a safe and effective means to treat iron deficiency in children who cannot receive or do not respond to oral iron due to intolerance, poor adherence, or iron malabsorption. Pediatr Blood Cancer 2011;56:615–619. © 2010 Wiley‐Liss, Inc.